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Challenges in Developing and Implementing Disaster Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention. Lisa M. Brown, Ph.D. Department of Aging and Mental Health Florida Mental Health Institute University of South Florida. Research Program.

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Challenges in Developing and Implementing Disaster Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Lisa M. Brown, Ph.D.

Department of Aging and Mental Health Florida Mental Health Institute

University of South Florida


Research Program Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Florida Older Adult Hurricane Study

Use of Disaster Mental Health Service in Long-Term Care Facilities


2004 Hurricane Season Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

  • Hurricane season is June 1 through November 30

  • Florida was impacted by 5 major storm systems during a 44 day period

    • Bonnie, Charlie, Frances, Ivan, Jeanne


2004 Hurricane Season Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

  • 2004 was the most intense hurricane season in Florida’s history

    • $60 billion damage

    • 117 deaths

    • Affected all 67 counties


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • National Hurricane Center predicted that Hurricane Charley would make landfall in Tampa as a category 2 hurricane early afternoon on August 13

  • Less than two hours later, the storm strengthened in intensity and veered 70 miles south, arriving unexpectedly in Charlotte County as a category 4 storm

    • Sustained winds of 145 miles per hour

    • Wind gusts that exceeded 180 miles per hour

    • Killed 34 people (2 older adults died by suicide)

    • $6.8 billion in damage


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

Pre-Hurricane Data

  • 1997 – 466 participants

  • 2002 - 236 participants

  • 60 to 84 years

    Comprehensive battery of measures:

    • Cognition  Medical & Physical  Mood

    • Personality  Social support  Mastery

    • Religion  Demographics  QoL


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

Post-Hurricane Data

  • 2 months – 167 participants

  • 8 months – 160 participants

  • 14 months – 153 participants

  • 23 months – 140 participants*

    (*anticipated)


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • Few studies have pre-disaster data (only 11 studies have pre-disaster data) – single measure of mood

  • Majority of disaster studies start 12 to 14 months after the event

  • How people recovery after a disaster is unclear

  • Why people don’t use disaster mental health services is unknown


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • Compare pre-disaster levels of mood and well-being to post-disaster levels

  • Examine posttraumatic stress disorder (PTSD) and posttraumatic growth

  • Study mental health service use

  • Evaluate use of social marketing to improve outreach efforts


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

Disaster questionnaire assessed:

  • Damage to home and community

  • Physical injuries to self or family members

  • Feelings of safety, panic, danger, ability to cope, confidence, fear of future hurricanes

  • Experience with previous disasters

  • Attitudes toward media, government, and recovery services


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • Would you describe yourself as a victim of Hurricane Charley? (friends and relatives description?)

  • Were you well prepared to deal with Hurricane Charley? (general public, federal, state, local government?)

  • If you evacuated, why, where, how long, what did you take?

  • Did you apply for assistance? Received? Pending? Adequate?


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • Did you receive help from a counselor or mental health professional to help you deal with your reaction to the hurricane or for an emotional or mood problem?

  • Who provided these services?

  • How many times did you received mental health services?

  • If you received mental health services, were they helpful?


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • 98% reported damage to home or property

  • 51% reported major structural damage

  • 88% lost electricity

  • 43% lost furniture or furnishings

  • 12% lost keepsakes


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • 31% feel less safe now than before Hurricane Charley

  • 28% felt a sense of panic during the hurricane

  • 20% felt their life was in danger during the hurricane


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • 2 months -14% reported significant levels of depression (5% in 1997)

  • 8 months -16% reported significant levels of depression

  • 30% were out of the area when the hurricane struck but reported levels of depression that was equal to the group that experienced the hurricane


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • 2 months - 2% over cutoff on PTSD Checklist

  • 8 months - 11% over cutoff on PTSD Checklist

  • 2 months – 27% rated their mental health as worse or much worse since the hurricane

  • 8 months -28% rated their mental health as worse or much worse since the hurricane


Florida Older Adult Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and InterventionHurricane Study

  • 2 months – 1% were using disaster mental health services

  • 8 months – 4% were using mental health services

    Use of disaster mental health services was not commensurate with disaster related mental health distress


Disaster mental health outreach and service
Disaster Mental Health Outreach and Service Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Empirical evidence from our study, along with reports from community and state agencies (AAA and DCF) who provided disaster mental health services, reveals that a substantial gap exists between those who are psychologically distressed and use of mental health services.


Disaster mental health outreach and service1
Disaster Mental Health Outreach and Service Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

It is not well understood why few older adults used disaster mental health services despite:

  • Aggressive outreach efforts

  • In-home services

  • Groups held in community centers

  • Free or low-cost programs

  • Psychological distress


Disaster mental health outreach and service2
Disaster Mental Health Outreach and Service Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Older adults are less likely to use mental health services in traditional mental health settings due to a complex set of help-seeking factors:

  • Problem recognition

  • Symptom misattribution

  • Readiness to change

  • Knowledge about services

  • Preferences for services

  • Barriers to treatment

    However, none of these studies were conducted with older adults who had survived a disaster and were contending with disrupted social networks, destroyed communities, and damaged homes.


Ltc and disaster mental health services
LTC and Disaster Mental Health Services Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Survey of 168 Nursing homes

88% LTC facilities were affected by the 2004 or 2005 hurricanes

Residents were mentally or emotionally distressed

17.5% reported none

43.7% reported 1% to 19%

12.5% reported 20% to 39%

11.3% reported 40% to 59%

1% reported 60% to 79%

1% reported 80% - 100%


Ltc and disaster mental health services1
LTC and Disaster Mental Health Services Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Residents were depressed

26.2 % Reported none

40% reported 1% to 19%

12.5% reported 20% to 39%

11.2% reported 40% to 59%

1% reported 60% to 79%

1% reported 80% - 100%


Ltc and disaster mental health services2
LTC and Disaster Mental Health Services Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Residents were anxious

21.2 % reported none

38.7 % reported 1% to 19%

20 % reported 20% to 39%

1% reported 40% to 59%

1% reported 60% to 79%

1% reported 80% - 100%


Ltc and disaster mental health services3
LTC and Disaster Mental Health Services Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Residents anxious about upcoming hurricane season

32.5 % reported none

32.5 % reported 1% to 19%

11.2 % reported 20% to 39%

1% reported 40% to 59%

1% reported 60% to 79%

1% reported 80% - 100%


Ltc and disaster mental health services4
LTC and Disaster Mental Health Services Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

  • 6% facilities would have used, but did not have available disaster mental health services

  • 27% used disaster mental health services

  • Services were provided by social workers (23.3%) and psychologists (12.4%) nurses (5.4%) psychiatrists (1%)


Ltc and disaster mental health services5
LTC and Disaster Mental Health Services Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

  • What percentage of residents found disaster mental health services helpful?

  • 35% reported none

  • 31% reported 1% to 19%

  • 17.3% reported 20% to 39%

  • 1% reported 40% to 59%

  • 1% reported 60% to 79%

  • 1% reported 80% - 100%


Implications
Implications Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

  • Research is needed to evaluate existing outreach efforts

  • More effective marketing of disaster mental health services

    • Many elders don’t want to be known as needing mental health services

    • Many elders don’t consider themselves as special needs

  • Responders who provide care to elders should have training specific to older adults


Implications1
Implications Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

  • Cooperative planning should occur at local, state, and federal levels

    • Special needs shelters

    • Education about disaster planning – advance directive format

  • Programs to enhance resilience and disaster preparedness of community dwelling elders

  • Training or protocols for home health aids

  • Programs for institutionalized adults


Lisa M. Brown, Ph.D. Behavioral Health Care Programs for Older Adults– Outreach, Assessment, and Intervention

Department of Aging and mental Health

Florida Mental Health Institute, MHC 1441

University of South Florida

13301 Bruce B. Downs Blvd.

Tampa, Florida 33612

813 – 974 – 0098

[email protected]


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