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Disaster Behavioral Health. Randal Beaton, PhD, EMT. Tools and Resources for Idaho Emergency Responders. Southeastern Health District 6. What type of organization do you work for?. Participant Poll. A. Hospital B. EMS, pre-Hospital C. Health District D. Other.

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Disaster behavioral health

Disaster Behavioral Health

Randal Beaton, PhD, EMT

Tools and Resources for Idaho Emergency Responders





What type of organization do you work for
What type of organization do you work for?

Participant Poll

A. Hospital

B. EMS, pre-Hospital

C. Health District

D. Other

Research professor schools of nursing and public health and community medicine
Research ProfessorSchools of Nursing and Public Health and Community Medicine

Randal Beaton, PhD, EMT

Faculty Northwest Center forPublic Health Practice University of Washington

Relevant clinical experience
Relevant Clinical Experience

  • Volunteer EMT

  • Counseled victims of 9/11 who lostco-workers

  • “Psychological casualties” of Nisqually earthquake (2001)

  • Stress management for First Responders – mostly firefighters and paramedics – in private practice

Relevant teaching and research background
Relevant teaching and research background

  • Published studies on benefits of disaster training and drills

  • NIOSH funded research into cause and effects of PTSD in firefighters

  • Core faculty of HRSA funded BT Curriculum Development Grant(UW ’03 – present)

  • Helped to write and drill UWSchool of Nursing Disaster Plan – 2002

Preamble assumptions

Disasters generally refer to natural or human caused events that cause property damage and large numbers of casualties.

Community wide disasters generally require outside assistance and/or assets.

Tsunami disaster
Tsunami Disaster

Photo by Dr. Mark Oberle, Phuket, Thailand

Effects on victims care givers
Effects on Victims & Care Givers

Disasters can also affect the psychological, behavioral, emotional and cognitive functioning of the disaster victims (primary, secondary, tertiary, etc.) and rescue workers, first responders and first receivers.

Tsunami disaster victims
Tsunami Disaster Victims

Photo by Dr. Mark Oberle in Phuket

Overarching goal
Overarching Goal

Enhance the networking capacity and training of state of Idaho healthcare professionals to recognize, treat and coordinate care related to behavioral health consequences of bioterrorism and other public health emergencies.

HRSA critical benchmark #2-8

  • These training modules will address:

  • behavioral health aspects of disasters

Disaster cycle
Disaster Cycle

There are a number of distinct

conceptual stages in the disaster cycle:

Pre-event warning threat stage

Preparedness Planning






Disaster behavioral health1
Disaster Behavioral Health

Disaster behavioral health interventions differ from traditional behavioral health practice by:

  • Addressing Incident-specific, stress reactions

  • Providing outreach andcrisis counseling to victims

  • Working hand-in-hand with paraprofessionals, volunteers, community leaders, and survivors ofthe disaster

Source : http://www.disastermh.nebraska.edu/state_plan/Appendix%20D.pdf

Aims of disaster behavioral health
Aims of Disaster Behavioral Health

  • To prevent maladaptive psychological and behavioral reactions of disaster victims and rescue workers


  • To minimize the counterproductive effects such maladaptive reactions might have on the disaster response and recovery

Disaster behavioral health2

Disaster Behavioral Health

Randal Beaton, PhD, EMT

Modules 1,2 & 4

Psychological phases of a disaster; Temporal patterns of mental/behavioral response to disaster; (Resilience briefly); Signs & symptoms of disaster victims

Learner objectives modules 1 4
Learner Objectives: Modules 1 - 4

  • Identify the psychosocial phases of a community-wide disaster and to describe the behavioral health tasks of disaster personnel during each phase

  • Describe the various temporal patterns of behavioral health outcomes following a disaster, including resilience

  • Identify the signs and symptoms of disaster victims, first responders and first receivers who may need a psychological evaluation

Module 1 psychosocial phases of a disaster
Module 1: Psychosocial Phases of a Disaster


* From Zunin & Myers (2000)

Implications tasks of each phase for disaster personnel pre disaster
Implications/Tasks of each Phase for Disaster Personnel - Pre-disaster

  • Warning – e.g. weather forecast

  • Educate

  • Inform

  • Instruct

  • Evacuate or “stay put”

Pre disaster
Pre-Disaster Pre-disaster

  • Threat, e.g., impending terrorist activity

  • Risk communication: To reduce anxiety, must also tell people what they should do (without jargon)

Impact Pre-disaster

  • Prepare for surge

  • Advise/instruct/give directions

  • Risk Communication update

  • Leadership

Heroic Pre-disaster

Disaster survivors are true “First Responders”

Honeymoon community cohesion
Honeymoon (community cohesion) Pre-disaster

  • Survivors may be elated and happy just to be alive

  • Realize this phase will not last

Disillusionment Pre-disaster

  • Reality of disaster “hits home”

  • Provide assistance for the distressed

  • Referrals to disaster mental health professionals

Inventory Pre-disaster

Psychological community needs assessment

  • Short-term

  • Mid-range

  • Downstream needs

Working through grief coming to terms
Working Through Grief (coming to terms) Pre-disaster

  • This is when disaster victims actually begin to need psychotherapy and/or medications (only a small fraction)

  • Trigger events – reminders

  • Anniversary reactions – set back

Reconstruction a new beginning
Reconstruction (“a new beginning”) Pre-disaster

Still, even following recovery, disaster victims may be less able to cope with next disaster

Behavioral health tasks by phase
Behavioral Health Tasks, by Phase Pre-disaster

Available at:


Behavioral health tasks by phase continued
Behavioral Health Tasks, by Phase, Continued Pre-disaster

Available at:


Module 2 temporal patterns of mental behavioral responses to disaster
Module 2: Temporal Patterns of Pre-disasterMental/Behavioral Responses to Disaster

Resilience Pre-disaster

  • Differs from recovery

  • Individuals “thrive”

  • Relatively stable trajectory

Module 2 temporal patterns of mental behavioral responses to disaster1
Module 2: Temporal Patterns of Pre-disasterMental/Behavioral Responses to Disaster

Acute distress and recovery
Acute Distress and Recovery Pre-disaster

  • Post-disaster recovery usually occurs within:

    • Days

    • Weeks

    • A few months

Module 2 temporal patterns of mental behavioral responses to disaster2
Module 2: Temporal Patterns of Pre-disasterMental/Behavioral Responses to Disaster

Chronic distress
Chronic Distress Pre-disaster

Acute/Chronic Distress and/or Lasting Maladaptive Health Behavior Outcomes

Module 2 temporal patterns of mental behavioral responses to disaster3
Module 2: Temporal Patterns of Pre-disasterMental/Behavioral Responses to Disaster

Delayed Onset Distress

For more information
For more information: Pre-disaster

Coping With a Traumatic Event

CDC Publication

Available at:http://www.bt.cdc.gov/masstrauma/copingpub.asp

Module 4 signs symptoms suggesting need for psychological evaluation
Module 4: Signs & Symptoms Suggesting Need for Psychological Evaluation

  • Suicidal or homicidal thoughts or plan(s)

  • Inability to care for self

  • Signs of psychotic mental illness – hearing voices, delusional thinking, extreme agitation

Signs and symptoms continued
Signs and Symptoms, continued Evaluation

  • Disoriented, dazed – not oriented x 3; recall of events impaired (R/O TBI)

  • Clinical depression – profound hopelessness and despair, withdrawal and inability to engage in productive activities

Signs and symptoms continued1
Signs and Symptoms, continued Evaluation

  • Severe anxiety – restless, agitated, inability to sleep for days, nightmares, overwhelming intrusive thoughts of the disaster

  • Problematic use of alcohol or drugs

Signs and symptoms continued2
Signs and Symptoms, continued Evaluation

  • Domestic violence, child or elder abuse

  • Family members feel their loved ones are acting in uncharacteristic ways

For more information1
For more information: Evaluation

Field Manual for Mental Health and Human Service Workers in Major Disasters

Available at:



Disaster behavioral health3

Disaster Behavioral Health Evaluation

Randal Beaton, PhD, EMT

Module 10

Post-Disaster Assessment

Learner objective module 10
Learner Objective Evaluation: Module 10

To identify and describe some basic principles of a post-disaster assessment of community psychosocial needs.

Principles of psychological needs assessment post disaster
Principles of Psychological Needs Assessment Post-disaster Evaluation

  • Type of Disaster

  • Vulnerable populations

  • Scope of the disaster

  • Downstream factors

Disaster typology
Disaster Typology Evaluation

“It is not the event but the Evaluationeffect

that makes the disaster.”

Vulnerable populations community composition
Vulnerable Populations Evaluation(Community Composition)

  • Psychiatric populations

  • Children/infants – Schonfeld Hot Topic Archive

  • Elderly

  • Pregnant Women

  • Women with young children

  • Native American Tribes

Population Exposure Model Evaluation

DeWolfe, see SAMHSA publication

Population exposure model dewolfe
Population Exposure Model Evaluation (DeWolfe)

  • Seriously injured victims • bereaved family members

  • Victims with high exposure to trauma • victims evacuated from the disaster zone

  • Bereaved extended family members and friends • rescue and recovery workers with prolonged exposure • medical examiner’s office staff • service providers directly involved with death notification and bereaved families

Population exposure model dewolfe continued
Population Exposure Model Evaluation (DeWolfe) (continued)

  • People who lost homes, jobs,pets, valued possessions • mental health providers • clergy, chaplains, spiritual leaders • emergency health care providers •school personnel involved with survivors, families, of victims • media personnel

  • Government officials • groups that identify with target victims group • businesses with financial impacts

  • Community-at-large

Downstream factors
Downstream Factors Evaluation

  • Economic impact on community

  • Job loss

  • Housing needs

  • Community Disruption

  • Loss of “symbols”

Red cross role in needs assessment
Red Cross Role ( Evaluationin needs assessment)

  • Can “assist” disaster victims

  • Make appropriate referrals

Disaster response and recovery
Disaster Response and Recovery Evaluation

Disaster Response and Recovery: A Handbook for Mental Health Professionals available at: http://www.empowermentzone.com/disaster.txt

Disaster behavioral health4

Disaster Behavioral Health Evaluation

Randal Beaton, PhD, EMT

Module 13

Providing Post-Disaster Behavioral Health Assistance

Learner objective module 13
Learner Objective Evaluation: Module 13

  • To describe some basic approaches to (early) post-disaster behavioral health assistance for disaster victims

TopOff 2 Evaluation

Key principles of post disaster behavioral health approaches
Key Principles of Post Disaster Behavioral Health Approaches Evaluation

  • No one who experiences a disaster first hand is unfazed

  • Disaster stress and grief reactions are normal and expected – “normalize” these reactions

Key principles of post disaster behavioral health approaches continued
Key Principles of Post Disaster Behavioral Health Approaches (continued)

  • Many emotional reactions of disaster survivors stem from problems of living brought about by the disaster

  • Most disaster survivors do not see themselves as needing behavioral health services following a disaster

Key principles of post disaster behavioral health approaches continued1
Key Principles of Post Disaster Behavioral Health Approaches (continued)

  • Disaster survivors may reject all forms of disaster assistance

  • Disaster behavioral health assistance is more practicalthan psychological

  • Disaster behavioral health services need to be uniquely tailored to the communities they serve

Therapy by just walking around

Things to Remember (continued)

“Therapy by just walking around”

Highest priority for counseling efforts disaster workers

Things to Remember (continued)

Highest priority for counseling efforts: Disaster workers

Disaster counselors assume a variety of roles: “carry water”, pitch tents, serve meals and “listen”.

Helping survivors in the wake of disaster resource
Helping Survivors in the Wake of Disaster Resource (continued)

A National Center for PTSD Fact Sheet Available at: http://www.ncptsd.org/facts/disasters/fs_helping_survivors.html

Disaster behavioral health5

Disaster Behavioral Health (continued)

Randal Beaton, PhD, EMT

Module 16: Rural Issues

Learner objective module 16
Learner Objective (continued): Module 16

To identify some special considerations for rural settings in terms of disaster behavioral health preparedness, response and recovery

Module 16
Module 16: (continued)

Rural Mental Health Preparedness versus Urban Settings

Rural america
Rural America (continued)

  • 65 million Americans

  • Frontier/Small towns

  • Transportation/highway systems

  • Rural “attitude”

Rural america1
Rural America (continued)

  • Sites of Farms (food supply)

  • Sites of power facilities (including nuclear)

  • Sites of headwaters and reservoirs (water supply)

Rural emergency preparedness
Rural Emergency Preparedness (continued)

  • Rural health departments have less capacity/resources/range of personnel.

  • Downsizing of rural hospitals has decreased/eliminated infrastructure.

  • EMS systems rely on volunteers.

  • General lack of funding and equipment.

Rural preparedness
Rural Preparedness (continued)

  • Several preparedness planning challenges are relatively unique to rural areas (e.g. coordination between state bioterrorism staff and Tribal nations).

Rural preparedness1
Rural Preparedness (continued)

  • Rural areas are affected by weather, tourism, a fragile financial and economic based and are geographically isolated, making it difficult to support medical systems.

Rural preparedness barriers
Rural Preparedness: Barriers (continued)

  • The main barrier to rural preparedness is lack of funding.

Rural preparedness2
Rural Preparedness (continued)

  • The Federal Government and the States must be financial partners but implementation must occur at a local level.

Rural mental health preparedness
Rural Mental Health Preparedness (continued)

  • Not much good research

  • Perceived risks – terror vectors

    • Agri-terrorism; water sources

  • Paucity of resources – personnel and PPE

  • Evacuation issues

    • Communication

  • Pathogens will not spare rural communities:

    • Native Alaskan Flu of 1918

Rural risk communication
Rural Risk Communication (continued)

  • Local news broadcasters viewed as more credible

  • Perception is that terrorists will target urban population centers

  • Terrorists might target rural settings – so no one feels safe!

Rural health concerns resource
Rural Health Concerns Resource (continued)

  • Bridging the Health Divide: The Rural Public Health Research Agenda available at:http://www.upb.pitt.edu/crhp/Bridging%20the%20Health%20Divide.pdf

    University of Pittsburgh publication