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6: Toolkit Part 2: Behavioral Health
Pages 125-144

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From page 125...
... Preparedness activities should address issues such as strategies for identification, monitoring, and interventions geared toward stress reduction and management, as well as postrecovery resilience promotion and mitigation of posttraumatic stress disorder. During an emergency, communities are confronted with a surge in demand and need for behavioral health intervention in health care facilities, in sheltering sites, at numerous public and private outpatient care venues, and through risk and crisis messaging and communications.
From page 126...
... 2012 report Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response. Special Circumstances All extreme events require understanding of, and adaptation to, new and complex challenges.
From page 127...
... DISCUSSION AND DECISION-SUPPORT TOOL Building on the scenarios and overarching key questions presented in Chapter 3, this tool contains additional questions to help participants drill down on the key issues and details for behavioral health. It also contains a chart that provides example behavioral health indicators, triggers, and tactics, and a blank chart TOOLKIT PART 2: BEHAVIORAL HEALTH 127
From page 128...
... Discussion Participants and Key Stakeholders Suggested participants and key stakeholders for a discussion focused on behavioral health are listed below. • State and local public health agencies; • State disaster medical advisory committee; • State and local emergency medical services agencies; • State and local emergency management agencies; • Health care coalitions (HCCs)
From page 129...
... 11. What epidemiological surveillance capabilities and indicators require monitoring of behavioral health factors?
From page 130...
... 13. What epidemiological surveillance capabilities and indicators require monitoring?
From page 131...
... It is important to recognize, however, that expert analysis of one or more indicators may also trigger implementation of key response plans, actions, and tactics. This may be particularly true in a slow-onset scenario.
From page 132...
... service needs capacity • EDs threaten closure because of inability • Identify areas and/or populations • X% increased psychiatric presentations in ED to manage BH-related cases (e.g., no beds, with different patterns of • X% increased calls to BH crisis lines no referral options) recovery • X% increased waiting list for appointments in Tactics: BH providers • Implement a variety of local mutual aid • X% of BH providers report seeing only agreements and federal disaster medical emergency cases assistance teams and National Disaster Tactics: Medical System resources (NN)
From page 133...
... (NN) Crisis triggers: • General services are compromised and goods • HCOs report that they can no longer admit are in short supply, causing increased anxiety patients exhibiting acute anxiety and and agitation agitation • BH providers report delays and short supplies • Alternative care/diversion programs (e.g., of prescription medication (e.g., antipsychotic, domestic violence shelters)
From page 134...
... Triggers: • Expand work-from-home programs (SO) • HCOs report that they can no longer admit • Seek funding and other resources, patients exhibiting acute anxiety and agitation including government • Alternative care resources and diversion- • Implement alternative internal and receiving facilities are at capacity and cannot response-related communication protocols admit more (NN)
From page 135...
... • EAP resources approach capacity among health workforce allows • Increases in requests for psychological fitness • Requests for psychological fitness for duty for resumption of routine staffing for duty assessments of staff assessments of staff approach capacity to ratios • Increased reports of stress-related sequelae process • Absenteeism/presenteeism in other systems (e.g., law enforcement, social • Increasing reports of stress-related declines services, faith organizations, etc.) sequelae in other systems (e.g., law • Requests for psychological Triggers: enforcement, social services, faith fitness-for-duty assessments of • Requests to BH staff for patient evaluations organizations, etc.)
From page 136...
... and bereaved family members share space alternative space usage, freeing Triggers: and services (NN) up beds for BH patients • Specialty psychiatric units exceed capacity • Increasing BH problems resulting from • Care and consultation again • Hospital triage results in BH patients being social distancing (e.g., depression, suicide, begin to occur face to face discharged before scheduled substance abuse, etc.)
From page 137...
... (EMS) , hospital encounters enforcement, HCO encounters • Reports of self-medication increase • Health care organizations are referring • HCOs see a declining number of • Increasing numbers of patients begin to increasing numbers of patients patients experiencing/exhibiting experience/exhibit withdrawal symptoms experiencing/exhibiting withdrawal withdrawal symptoms Triggers: symptoms Triggers: • Demand for psychiatric medications and Crisis triggers: • Demand for psychiatric medications used to treat substance abuse • Key psychiatric and substance abuse medications and medications disorders increases by X% treatment medications are no longer used to treat substance abuse • X% reduction in supply of psychiatric available disorders returns to baseline medications and medications used to treat • Self-medication becomes a significant • Supply of psychiatric medications substance abuse disorders factor in large numbers of law enforcement and medications used to treat • X% increase in numbers of behaviorally and health care organization encounters substance abuse disorders agitated patient requests for detox services and compromises systems function (e.g., adequate to meet community for withdrawal symptoms of any type (from a adverse impact on worker productivity, needs wide variety of licit and illicit drugs)
From page 138...
... • Seek advice from BH bereavement specialists, specialists, DMORTs, faith community, Tactics: disaster mortuary operational response other experienced sources • Evaluate and modify mass fatality teams (DMORTs) , faith community, other • Expand risk/crisis communication training plans experienced sources • Continue to convene stakeholders on a • Update roster of BH bereavement • Review and provide risk/crisis communication regular basis to monitor and assess trends/ specialists, DMORTS, faith training issues community, other experienced • Convene stakeholders on a regular basis to • Implement mutual aid (including sources monitor and assess trends/issues temporary morgues)
From page 139...
... for tone, targeted messages, social media responses reflects current standards of care accuracy, usability, consistency • Provide just-in-time crisis communication and status of health system • Obtain information from nontraditional training for formal and informal leaders Tactics: sources to determine how information is being • Seek specialized consultation and advice • Evaluate and revise crisis provided/interpreted in vulnerable or specific regarding risk/crisis communication communication plans cultural groups • Increase content monitoring and analysis • Institutionalize crisis of media for tone, accuracy, usability, communication training for consistency formal and informal leaders • Update roster of specialized consultants/advisers in risk/crisis communication continued 139
From page 140...
... TABLE 6-1 140 Continued Indicator Category Contingency Crisis Return Toward Conventional Other categories: • Deploy crisis counseling teams to health • Continue and enhance content Risk/crisis resource lines to address social unrest monitoring and analysis of media communications • Convene stakeholders regarding issues of, for tone, accuracy, usability, (continued) and strategies for, crisis communication consistency • Focus on positive accomplishment or • Continue to convene developments in communications stakeholders regarding issues • Meet with major media to emphasize of, and strategies for, crisis gravity of situation and attempt to address communication conflicts in messaging • Focus on positive accomplishments/developments • Continue to aggressively address rumors and monitor new developments
From page 141...
... • The key questions were designed to facilitate discussion -- customized for behavioral health -- about the following four steps to consider when developing indicators and triggers for a specific organization/agency/jurisdiction: (1) identify key response strategies and actions, (2)
From page 142...
... 142 Scope and Event Type: __________________________________ Indicator Category Contingency Crisis Return Toward Conventional Surveillance data Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Communications and Indicators: Indicators: Indicators: community infrastructure Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Staff Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Space/infrastructure Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Supplies Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics: Other categories Indicators: Indicators: Indicators: Triggers: Crisis triggers: Triggers: Tactics: Tactics: Tactics:
From page 143...
... 2012. Crisis standards of care: A systems framework for catastrophic disaster response.


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