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  1. Workforce Resilience and Performancein the Face of Disasters, Terrorism, and Emerging Health Threats Dori B. Reissman, M.D., M.P.H. CDR, U.S. Public Health Service Senior Advisor for Disaster Mental Health and Terrorism CDC’s National Center for Injury Prevention and Control PHP Conference Feb 23, 2005

  2. Session Organization • Dori B. Reissman, M.D., M.P.H. • “Integrating Workforce and Organizational Resilience into the Response Culture of Public Health” • Kathleen Kowalski Trakofler, Ph.D. • “Pragmatic Approaches to Creating Workforce and Organizational Resilience in Public Health Emergency Operations

  3. Learning Objectives • Explain to decision makers the need to anticipate and integrate behavioral and social needs into advance planning efforts to optimize medical and public health systems of care • Address workplace policy and programmatic design to promote resilience amongst public health responders

  4. ACT The BALANCING PUBLIC HEALTH of

  5. Exercise indicators will include behavioral and mental health components to build local capacity (public health readiness) Grant guidance includes language to anticipate and integrate behavioral aspects and mental health needs and services for populations exposed to traumatic events Grants to State Health Departments

  6. Fear-Inducing Factors in Emerging Biological Events • Biological agent is invisible & odorless • Biological agent may be contagious • Biological agent may cause death or severe health problems • Many casualties, widespread • Access to effective treatment • No available treatment Hall, M., Norwood, A., Ursano, R., & Fullerton, C. (2003). The psychological impacts of bioterrorism. Biosecurity and Bioterrorism, 1, 139-44.

  7. Fear-Inducing Factors in Emerging Biological Events • Cause of the event may not be familiar, which breeds “magical” thinking • Public information is inadequate or conflicting • Uncertainty about how to avoid sickness • Uncertainty about where to get help Hall, M., Norwood, A., Ursano, R., & Fullerton, C. (2003). The psychological impacts of bioterrorism. Biosecurity and Bioterrorism, 1, 139-44.

  8. Substantial investments are spent in search of the best treatment strategy, but relatively little attention is paid evaluating emotional and behavioral reactions to mass dispensing

  9. Issues That Need to Be Addressed • Surge in public demand for medical attention • Public’s concern about exposure and safety • Incomplete knowledge as events unfold • Conflicting expert opinion about treatment • Perceived mismatch of governmental action and public expectations • Reluctance to follow health directives

  10. Flu Shot Demand Rises Sharply In Colorado, Flu Outbreak Has Killed at Least 5 Children Shortage of Flu Shots Prompts Rationing Vaccine Being Reserved For Highest-Risk Patients

  11. West Nile Virus

  12. ANTHRAX

  13. 1971 U.S. civilian vaccination stopped 2003 38,257 civilians vaccinated SMALLPOX (as of 8/8/03)

  14. The Fear

  15. PUBLIC HEALTH 72 total U.S. cases 37 lab-confirmed 35 suspect or probable Monkeypox

  16. Phases of Natural Disaster Honeymoon(Community Cohesion) ReconstructionA New Beginning “Heroic” Disillusionment Warning (Coming to Terms) Working Through Grief Threat Impact Pre-disaster Trigger Events and Anniversary Reactions Inventory Time Days Years [Zunin & Meyers]

  17. Florida Hurricane Season 2004

  18. Mass fatalities: preserved with dry ice on grounds of Wat (temple) Yan Yao in Takuapa, Thailand. 2004 Indian Ocean Tsunami

  19. 2004 Indian Ocean Tsunami:Health-Related Infrastructure Loss in Banda Aceh Damage outside Meuraxa Hospital Damage to the lab equipment at the Provincial Hospital

  20. Psychological Consequences of Disasters and Terrorism (R. Ursano, 2002) These can apply to responders, not just victims.

  21. Usual Sources of Stress on Deployment • Role ambiguity • Clarity of tasking • Matching skills with tasks • Team cohesion • Comfort with hazardous exposure • Communication protocols

  22. 2. Usual Stresses for Responders • Autonomy and clearance • Intense local needs for information (media and health officials) that cannot await clearance delay • Database issues, linkage between epidemiology, laboratory, and environmental sampling • Laboratory specimen tracking, reporting

  23. 3. Usual Stresses for Responders • Resources/equipment shortages • Command and control ambiguities • Re-integration barriers • Coworkers had to pick up your work… or no one did and it is overwhelming • Lack of understanding or appreciation for what you have been through • Domestic/family conflict

  24. Endpoints for Evaluation (Agency) • Workforce productivity (re-integration) • Intra-agency collaboration • Interagency coordination (local response plans) • Rules of engagement and integration with constituent partners • Workforce absenteeism (post-event) • Command and control strategies (e.g., ICS/UCS) • Workforce morale

  25. Endpoints for Evaluation (Individual) • Quality of life • Sense of satisfaction with home, work, friends, family, health, hobbies • Existential or world view • Functional capacity • Social, family, and occupational roles • Behavioral adaptation and coping • Thinking and planning skills

  26. Workplace Resilience Program • Formal needs assessment • Key leadership and service provider training • Developing curricula and support tools to launch a program for deployable staff • Assuring infrastructure to provide event-response and post-response intervention services (including surge capacity)

  27. Why does this matter? • Preservation of personnel assets for emergency response • Time, energy, and cost of workforce training • Preparedness improves response readiness and may hasten recovery • Mission success • Effective re-integration to “day job” • Minimize loss of productivity and work absenteeism • Possibility of post-traumatic growth • Potential individual and agency gains

  28. Acknowledgements • 2005 Operation Earthquake Mental Health and Resilience Team, CDC Emergency Operations • Academic & Specialty Centers for Public Health Preparedness • Disaster Mental Health Institute of South Dakota • American Psychological Association • American Psychiatric Association • Carter Center Mental Health Program • Defense Threat Reduction Agency (DOD) • The National Center for Post-Traumatic Stress Disorder (Dept of Veterans Affairs) • The National Child Traumatic Stress Network • Potomac Institute/National Defense University • RAND Corporation (a non-profit institution) • Uniformed Services University of the Health Sciences, Dept of Psychiatry • US Dept of Health and Human Services • CDC • Substance Abuse and MH Services Administration • National Institute of Mental Health • Health Resources Service Administration