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Gaps and Challenges in the Integration of Public Health & Behavioral Health Disaster Response

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Abstract: …

Abstract:

Gaps and challenges in the integration of public health and behavioral health disaster response

Emergency management and public health services have provided leadership in disaster response programs due to safety and injury as primary concerns. Over the past thirty years, with the federal crisis counseling program responding to devastating events with long lasting emotional repercussions, behavioral health concerns have become recognized as the second leading effect of these events. Public health emergency services have made significant gains in planning and preparedness efforts on a national level as well as on a state by state basis. Requirements that public health departments integrate behavioral health services into their preparedness and response plans has proved difficult despite a growing awareness of the need to progress in this area.

Disaster behavioral health’s entrance into the public health domain brings with it new skills to be added to an already overloaded curriculum. The emerging disaster behavioral health field has struggled with the lack of evidence based early interventions and this has significantly slowed the public health discipline from identifying and training their disaster response workforce in best practices.

In the wake of the last decade of catastrophic disasters, emergency management and public health responders are increasing their awareness of the stress they themselves experience in their work and learning how to mitigate its effects. This is allowing more responders to understand the concept of a public health application to disaster behavioral health response and is serving to move the integration process forward. More behavioral health disaster research is needed to build a solid evidence base to support staged disaster recovery interventions.

Learning Objective: Participants in this session will be able to describe three ways that disaster behavioral health interventions may be integrated into an overall public health response to an emergency.

Summary:
This session discusses how public health and emergency management staff plan for disaster preparedness and recovery response activities to meet the needs of trauma victims of large-scale and scope events such as catastrophic weather events, public health emergencies and terrorist attacks involving mass casualties as examples. It will include background information, key concepts in public health and behavioral health response stressing integrating health and behavioral health approaches to disaster response.

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  • In a sea of documents, guides, policies, and requirements, it is often challenging to identify, adopt, and employ what is best for your organization.A critical step in the integration of public health and behavioral health disaster response is knowing what to use; when to use it; how to use it.
  • The National Incident Management System (NIMS) is alive and well. However, when not utilized on a routine basis, the principles and concepts of NIMS can become blurry, if not forgotten altogether. Preparedness requires the application and employment of NIMS, as well as the Incident Command System (ICS) when responding to, and recovering from various incidents and events.
  • According to Presidential Policy Directive (PPD) 8,National Preparedness is described as The actions taken to plan, organize, equip, train, and exercise to build and sustain the capabilities necessary to prevent, protect against, mitigate the effects of, respond to, and recover from those threats that pose the greatest risk to the security of the Nation.
  • Presidential Policy Directive 8: National Preparedness (PPD-8) describes the Nation’s approach to preparing for the threats and hazards that pose the greatest risk to the security of the United States. PPD 8 led to the creation of various Preparedness products, such as the National Preparedness Goal (NPG) and the National Preparedness System (NPS). Soon to come include various Preparedness Frameworks for Prevention, Protection, Mitigation, Response, and Recovery. To date, the National Response Framework (NRF) is already employed, as well as the National Disaster Recovery Framework (NDRF). Refinements to these, and the addition of others, will play a pivotal part in disaster response.As the integration of public health and behavioral health disaster response continues, it is critical to become very familiar with the PPD-8, NPG, NPS, and all of the Preparedness Frameworks, current and those to come.
  • The National Preparedness Goal described five Mission Areas
  • National preparedness is the shared responsibility of our whole community. Every member contributes, including individuals, communities, the private and nonprofit sectors, faith-based organizations, and Federal, state, and local governments. We describe our security and resilience posture through the core capabilities that are necessary to deal with great risks, and we will use an integrated, layered, and all-of-Nation approach as our foundation.Using the core capabilities, we achieve the National Preparedness Goal by:Preventing, avoiding, or stopping a threatened or an actual act of terrorism.Protecting our citizens, residents, visitors, and assets against the greatest threats and hazards in a manner that allows our interests, aspirations, and way of life to thrive.Mitigating the loss of life and property by lessening the impact of future disasters.Responding quickly to save lives, protect property and the environment, and meet basic human needs in the aftermath of a catastrophic incident.Recovering through a focus on the timely restoration, strengthening, and revitalization of infrastructure, housing, and a sustainable economy, as well as the health, social, cultural, historic, and environmental fabric of communities affected by a catastrophic incident.
  • Planning: Conduct a systematic process engaging the whole community as appropriate in the development of executable strategic, operational, and/or community-based approaches to meet defined objectives.Public Information and Warning: Deliver coordinated, prompt, reliable, and actionable information to the whole community through the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, as well as the actions being taken and the assistance being made available, as appropriate.Operational Coordination: Establish and maintain a unified and coordinated operational structure and process that appropriately integrates all critical stakeholders and supports the execution of core capabilities.Community Resilience: Lead the integrated effort to recognize, understand, communicate, plan, and address risks so that the community can develop a set of actions to accomplish Mitigation and improve resilience.Risk and Disaster Resilience Assessment: Assess risk and disaster resilience so that decision makers, responders, and community members can take informed action to reduce their entity’s risk and increase their resilience.Mass Care Services: Provide life-sustaining services to the affected population with a focus on hydration, feeding, and sheltering to those who have the most need, as well as support for reunifying families.Public Health and Medical Services: Provide lifesaving medical treatment via emergency medical services and related operations and avoid additional disease and injury by providing targeted public health and medical support and products to all people in need within the affected area.Health and Social Services: Restore and improve health and social services networks to promote the resilience, independence, health (including behavioral health), and well-being of the whole community.PreventionPlanningIdentify critical objectives based on the planning requirement, provide a complete and integrated picture of the sequence and scope of the tasks to achieve the objectives, and ensure the objectives are implementable within the time frame contemplated within the plan using available resources for prevention-related plans.Develop and execute appropriate courses of action in coordination with Federal, state, local, and private sector entities in order to prevent an imminent terrorist attack within the United State.Public Information and WarningShare prompt and actionable messages, to include National Terrorism Advisory System alerts, with the public and other stakeholders, as appropriate, to aid in the prevention of imminent or follow-on terrorist attacks, consistent with the timelines specified by existing processes and protocols.Provide public awareness information to inform the general public on how to identify and provide terrorism-related information to the appropriate law enforcement authorities, thereby enabling the public to act as a force multiplier in the prevention of imminent or follow-on acts of terrorism.Operational CoordinationExecute operations with functional and integrated communications among appropriate entities to prevent initial or follow-on terrorist attacks within the United States in accordance with established protocols.ProtectionPlanning1. Develop protection plans that identify critical objectives based on planning requirements, provide a complete and integrated picture of the sequence and scope of the tasks to achieve the planning objectives, and implement planning requirements within the time frame contemplated within the plan using available resources for protection-related plans.2. Implement, exercise, and maintain plans to ensure continuity of operations.Public Information and Warning1. Use effective and accessible indication and warning systems to communicate significant hazards to involved operators, security officials, and the public (including alerts, detection capabilities, and other necessary and appropriate assets).Operational Coordination1. Establish and maintain partnership structures among Protection elements to support networking, planning, and coordination.MitigationPlanning1. Develop approved hazard mitigation plans that address all relevant threats/hazards in accordance with the results of their risk assessment within all states and territories.Public Information and Warning1. Communicate appropriate information, in an accessible manner, on the risks faced within a community after the conduct of a risk assessment.Operational CoordinationEstablish protocols to integrate mitigation data elements in support of operations within all states and territories and in coordination with Federal agencies.Community Resilience1. Maximize the coverage of the U.S. population that has a localized, risk-informed mitigation plan developed through partnerships across the entire community. Risk and Disaster Resilience Assessment1. Ensure that states, territories, and the top 100 Metropolitan Statistical Areas (MSAs) complete a risk assessment that defines localized vulnerabilities and consequences associated with potential natural, technological, and human-caused threats and hazards to their natural, human, physical, cyber, and socioeconomic interests.ResponsePlanning1. Develop operational plans at the Federal level, and in the states and territories, that adequately identify critical objectives based on the planning requirement, provide a complete and integrated picture of the sequence and scope of the tasks to achieve the objectives, and are implementable within the time frame contemplated in the plan using available resources.Public Information and Warning1. Inform all affected segments of society by all means necessary, including accessible tools, of critical lifesaving and life-sustaining information to expedite the delivery of emergency services and aid the public to take protective actions.2. Deliver credible messages to inform ongoing emergency services and the public about protective measures and other life-sustaining actions and facilitate the transition to recovery.Operational Coordination1. Mobilize all critical resources and establish command, control, and coordination structures within the affected community and other coordinating bodies in surrounding communities and across the Nation and maintain as needed throughout the duration of an incident.2. Enhance and maintain National Incident Management System (NIMS)-compliant command, control, and coordination structures to meet basic human needs, stabilize the incident, and transition to recovery.Mass Care Services1. Move and deliver resources and capabilities to meet the needs of disaster survivors, including individuals with access and functional needs and others who may be considered to be at-risk.2. Establish, staff, and equip emergency shelters and other temporary housing options (including accessible housing) for the affected population.3. Move from congregate care to non-congregate care alternatives and provide relocation assistance or interim housing solutions for families unable to return to their pre-disaster homes.Public Health and Medical Services1. Deliver medical countermeasures to exposed populations.2. Complete triage and initial stabilization of casualties and begin definitive care for those likely to survive their injuries.3. Return medical surge resources to pre-incident levels, complete health assessments, and identify recovery processes.RecoveryPlanning1. Convene the core of an inclusive planning team (identified pre-disaster), which will oversee disaster recovery planning.2. Complete an initial recovery plan that provides an overall strategy and timeline, addresses all core capabilities, and integrates socioeconomic, demographic, accessibility, and risk assessment considerations, which will be implemented in accordance with the timeline contained in the plan.Public Information and Warning1. Reach all populations within the community with effective recovery-related public information messaging and communications that are accessible to people with disabilities and people with limited English proficiency, protect the health and safety of the affected population, help manage expectations, and ensure stakeholders have a clear understanding of available assistance and their roles and responsibilities.2. Support affected populations and stakeholders with a system that provides appropriate, current information about any continued assistance, steady state resources for long-term impacts, and monitoring programs in an effective and accessible manner.Operational Coordination1. Establish tiered, integrated leadership, and inclusive coordinating organizations that operate with a unity of effort and are supported by sufficient assessment and analysis to provide defined structure and decision-making processes for recovery activities.2. Define the path and timeline for recovery leadership to achieve the jurisdiction’s objectives that effectively coordinates and uses appropriate Federal, state, and local assistance, as well as nongovernmental and private sector resources. This plan is to be implemented within the established timeline.Health and Social Services:1. Restore basic health and social services functions. Identify critical areas of need for health and social services, as well as key partners and at-risk individuals (such as children, those with disabilities and others who have access and functional needs, and populations with limited English proficiency) in short-term, intermediate, and long-term recovery.2. Complete an assessment of community health and social service needs and develop a comprehensive recovery timeline.3. Restore and improve the resilience and sustainability of the health and social services networks to meet the needs of and promote the independence and well-being of community members in accordance with the specified recovery timeline.
  • The creation of the HHS Disaster Behavioral Health Concept of Operations (CONOPS) is a tremendous success for all. This document is intended to serve as the CONOPS for HHS, and is not intended to be copied and pasted into State, Territorial, Tribal, or Local Plans (STTL).STTL stakeholders, however, should utilize the HHS DBH CONOPS for reference purposes. At the same time, STTLs are expected to create their own policies, procedures, plans, and guides. In doing so, Comprehensive Planning Guide (CPG) 101 V.2 is the recommended guidance document to use throughout the STTL plan development process.
  • For the creation of STTL plans, CPG 101 V.2 is the guide of choice.
  • CPG 101 V.2 focuses on the fundamentals of planning, from the creation of the planning team, to the implementation and maintenance of your plan.The most important aspect of CPG 101 V.2 is the “Planning Process” rather than the plan alone. The “Planning Process” brings together key stakeholders and partners. This is where value is added, decisions are made, and challenges overcome. Working in a silo, in the absence of a planning team, and/or developing a plan in the absence of a “Planning Process” are dangerous approaches to plan development and management.Consequently, public health and behavioral health disaster response integration should include the integration into stakeholder plans, as well as the integration of stakeholders into PH and DBH plans.
  • Information technology & mobility are here, and they are here to stay. Health Information Technology (HIT) and Health Information Exchange (HIE) have gained tremendous traction throughout the Nation, and abroad. In January of 2006, a few months after Hurricane Katrina, I found myself in New Orleans, LA (NOLA) with graduate students from Tulane and the University of South Florida (USF) Colleges of Public Health, the NOLA Emergency Operations Center Planning Section, the U.S. Census Bureau, and the Centers for Disease Control and Prevention (CDC). We were conducting the first Public Health Population Estimate throughout NOLA. It was a success by all means, despite all surveys being paper based.At that time there was an interest in conducting survey estimates electronically, and consolidating data through the use of information technology and mobility solutions. However, the latest-and-greatest technological device we has was a handheld PDA in a Otterbox-like-case with no wireless capability. Running off a first generation software platform, an electronic survey solution was piloted. Just as Thomas Edison required many versions of the light-bulb before a solution was perfected, so has the information technology and mobility industries.From the ages of typewriters and payphones, to the use of handheld-smart-phones streaming at 4G; our world has been transformed through wireless connectivity and the management of tremendous amounts of information accessible in the palm of your hand.As a base-line, the amount of information we filter, process, and manage daily is unquantifiable. During disasters, and in the midst of a complex incident/event, there is an even greater need for having access to the right information, at the right time. And while having access to large amounts of information is important, having access to the correct information is invaluable. Information management made intelligent… this is made possible through the employment of HIT and HIE.
  • The report includes five recommendations that any public or private organization planning to share electronic health information during a disaster should consider. These recommendations are focused on the activities of State HIEs. The five recommendations for the State HIEs are:1.Understand the State’s disaster response policies and align with the State agency designated for Emergency Support Function #8 (Public Health and Medical Services) before a disaster occurs.2.Develop standard procedures approved by relevant public and private stakeholders to share electronic health information across State lines before a disaster occurs.3.Consider enacting the Mutual Aid Memorandum of Understanding to establish a waiver of liability for the release of records when an emergency is declared and to default state privacy and security laws to existing Health Insurance Portability and Accountability Act (HIPAA) rules in a disaster. States should also consider using the Data Use and Reciprocal Support Agreement (DURSA) in order to address and/or expedite patient privacy, security, and health data-sharing concerns.4.Assess the State’s availability of public and private health information sources and the ability to electronically share the data using HIE(s) and other health data-sharing entities.5.Consider a phased approach to establishing interstate electronic health information-sharing capabilities.Taken together, these recommendations offer a path forward for other States that wish to integrate disaster planning and HIE efforts. Combining these two important health care functions will help ensure that when a disaster strikes, patients and providers will have better access to information and be better able to provide appropriate care.Source: Southeast Regional HIT-HIE Collaboration (SEARCH): Final Report, ONC State Health Policy Consortium Project: Health Information Exchange in Disaster Preparedness and Response, July 2012, http://www.healthit.gov/sites/default/files/pdf/SERCH-White-Paper.pdf
  • Whereas there is a tremendous amount of activity going on in this slide, I want to leave you with this image illustrating the Health Information Exchange (HIE) landscape. Complex, comprehensive, and here to stay!
  • Transcript

    • 1. Gaps and Challenges in the Integration of Public Health & Behavioral Health Disaster Response -A Responder’s Perspective Anthony A. Barone, M.P.H., CHMM, CHS-V, FF/EMT-BImage: FEMA Stock ID 54866 Wednesday, October 31, 2012
    • 2. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 1
    • 3. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 2
    • 4. Presenter Disclosure The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: – No Relationships to Disclose Whereas today’s presenter is a member of a various organizations, both private and governmental, content provided herein is representative solely of the presenter’s perspective, experience, and lessons learned acquired throughout his career in the emergency preparedness arena. The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 4
    • 5. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 5
    • 6. Disaster Behavioral Health: Defined “… comprises the mental health issues related to disasters and the means of addressing them, including proactive methods to build resiliency and short- and long-term approaches to restoring and maintaining psychological and emotional health in the face of an emergency.” - PPHR “… the provision of mental health, substance abuse, and stress management to disaster survivors and responders.” - HHSProject Public Health Ready (PPHR) – 2012http://www.naccho.org/topics/emergency/PPHR/Criteria.cfm The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 6
    • 7. Disaster Behavioral Health: A Public Health Practice A common challenge with the integration of public health and behavioral health disaster response is the recognition of behavioral health as a public health practice. Just like environmental health, epidemiology, and biostatistics, behavioral health is a public health practice. Disaster Behavioral Health (DBH) further applies behavioral health concepts in times of a disaster to survivors, responders, and other populations. What is unique about DBH is that it applies to everyone: – Survivors of the affected community, individuals and populations of surrounding communities, and at times others across the Nation (e.g. Hurricane Katrina) and throughout the world (e.g. September 11, 2011 terrorist attacks) – Responders (e.g. Police, fire, EMS, utilities, volunteers, crisis counselors, etc.) – Providers (e.g. First receivers, mental health professionals, etc.)Image: FEMA Stock ID 33425 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 7
    • 8. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 8
    • 9. The Perfect PlanOne major challenge is knowing what to use; when to use it; how to use it... The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 9
    • 10. The Perfect Plan The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 10
    • 11. The Perfect Plan: National Incident Management System (NIMS) The National Incident Management System (NIMS) defines preparedness as "a continuous cycle of planning, organizing, training, equipping, exercising, evaluating, and taking corrective action in an effort to ensure effective coordination during incident response." This preparedness cycle is one element of a broader National Preparedness System to prevent, respond to, recover from, and mitigate against natural disasters, acts of terrorism, and other man-made disasters. http://www.fema.gov/preparedness-1Image: FEMA Stock ID 58278 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 11
    • 12. The Perfect Plan: Presidential Policy Directive (PPD) 8 – National Preparedness National Preparedness: The actions taken to plan, organize, equip, train, and exercise to build and sustain the capabilities necessary to… … prevent, … protect against, … mitigate the effects of, … respond to, and … recover from… … those threats that pose the greatest risk to the security of the Nation.Image: FEMA Stock ID 58278 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 12
    • 13. The Perfect Plan: Presidential Policy Directive (PPD) 8 – National Preparedness National Preparedness Goal National Preparedness SystemImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 13
    • 14. The Perfect Plan: National Preparedness Mission Areas Prevention Protection Mitigation Response RecoveryImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 14
    • 15. The Perfect Plan: National Preparedness Mission Areas “Whole Community” Prevention Protection Mitigation Response RecoveryImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 15
    • 16. The Perfect Plan: National Preparedness Mission Areas & Key Capabilities “Whole Community” Prevention Protection Mitigation Response 1.Community Recovery Resilience Mass Care 1. Planning Operational Public Information 2. Risk &Services Disaster 2. Public Health Resilience Medical Health and and 1. Coordination & Warning Services Social Services AssessmentImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 16
    • 17. The Perfect Plan The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 17
    • 18. The Perfect Plan The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 18
    • 19. The Perfect Plan: Federal, State, Territorial, Tribal, and Local Plans Federal Plans State, Territorial, Tribal, and Local Plans The Integrated Planning System (IPS) Comprehensive Planning Guide (CPG) 101 V.2  Describes planning doctrine and the  Describes the fundamentals of planning Federal plan development process and developing emergency plans  Provides structure for:  Provides guidance for: – Federal Strategic Plan – Strategic Plan – Federal Concept Plan – Operational Plan – Federal Operations Plan – Tactical Plan  Plans described:  Plans described: – Contingency (pre-incident/event) – Emergency Operations Plan (EOP) – Crisis Action (post-incident/event) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 20
    • 20. The Perfect Plan: Federal, State, Territorial, Tribal, and Local Plans Federal Plans State, Territorial, Tribal, and Local Plans The Integrated Planning System (IPS) Comprehensive Planning Guide (CPG) 101 V.2  Describes planning doctrine and the  Describes the fundamentals of planning Federal plan development process and developing emergency plans  Provides structure for:  Provides guidance for: – Federal Strategic Plan – Strategic Plan – Federal Concept Plan – Operational Plan – Federal Operations Plan – Tactical Plan  Plans described:  Plans described: – Contingency (pre-incident/event) – Emergency Operations Plan (EOP) – Crisis Action (post-incident/event) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 21
    • 21. The Perfect Plan: CPG 101 V.2 State, Territorial, Tribal, and Local Plans Comprehensive Planning Guide (CPG) 101 V.2  Describes the fundamentals of planning and developing emergency plans  Provides guidance for: – Strategic Plan – Operational Plan – Tactical Plan  Plans described: – Emergency Operations Plan (EOP) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 22
    • 22. The Perfect Plan: CPG 101 V.2 State, Territorial, Tribal, and Local Plans Comprehensive Planning Guide (CPG) 101 V.2  Describes the fundamentals of planning and developing emergency plans  Provides guidance for: – Strategic Plan – Operational Plan – Tactical Plan  Plans described: – Emergency Operations Plan (EOP) – Standard Operating Procedure / Guideline (SOP / SOG) – Field Operations Guide (FOG) or handbook The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 23
    • 23. The Perfect Plan: CPG 101 V.2 Introduction and Overview 1. The Basics of Planning 2. Understanding the Planning Environment: Federal, State, and Local Plans 3. Format and Function: Identifying the Right Plan for the Job 4. The Planning Process – Step 1: Form a Collaborative Planning Team – Step 2: Understand the Situation – Step 3: Determine Goals and Objectives – Step 4: Plan Development – Step 5: Plan Preparation, Review, and Approval – Step 6: Plan Implementation and Maintenance The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 24
    • 24. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 25
    • 25. Practice Integration• Public health and behavioral health disaster response lack consistantcollaboration and standardized integration with preparedness partners• The concept of the “Whole Comminity” calls for theleveraging, collaboration, and cooperation of all key players andstakeholders• Public Healh, as the lead for Emergency Support Function (ESF) 8:Public Health and Medical Services, is expected by the public to providehealth and medical direction, guidance, support, and services toindividuals, families, and communities during disasters•Disaster Behavioral Health services are an expectation of the public, anda critical need for responders The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 26
    • 26. Practice Integration Steps forward in the National Capital Region (NCR) • Regional preparedness and coordination efforts • Regional health and medical planning • Public health and behavioral health at the table with emergency management, public safety, hospitals, and others The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 27
    • 27. Practice Integration: Responder Focus  It’s time to take a second look at responders  Responders provide a unique challenge for public health and behavioral health disaster response: – Provide initial contact with survivors – Expected to triage and treat patients according to scope and protocol, maintain incident safety and security, and/or conduct other emergency operations – Subjected to continuous exposure to a disaster scene and traumatic incidents – Are often survivors themeslves – Lack standardized training, guidance, procedures, and protocols for application in the field • While many resources do exist, police/fire academies and EMS schools do not incorporate sufficient training, education, or competencies for respondersImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 28
    • 28. Practice Integration: Responder Focus “Psychological first aid is one of the most important skills my team can have in the field.” Christina Catlett, MD, FACEP Medical Officer, MD-1 DMAT Director, Johns Hokpins Go Team MRCImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 29
    • 29. Practice Integration: Responder Focus  Disaster Behavioral Health (DBH) integration into first/disaster responder training, education, and certification process would help bridge the DBH gaps during the initial interactions of the survivor and responder.  Standardized core DBH competencies for responders, in conjunction with requirements for skill demonstration (e.g. CPR, ACLS, etc.) would help bring DBH to life in practice, in training, and subsequently the field.  Standardized guidance for survivors provides an opportunity for unaffected survivors to actually care for responders. – For example, encouraging survivors to demonstrate appreciation to responders for their duties is a powerful tool in refreshing and refueling responders.Image: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 30
    • 30. Practice Integration: Responder Focus Time Operations You 0  Rotate On-call  Prepare, train, and exercise 12hr  Alerted and placed on standby  Check your gear, notify work, secure 24hr  Activated and provided family and property... and you wait... 48hr providers orders  Report to ralley-point  Deploy  Begin your journey 72hr  Travel by land, air, sea, land  While excited, you are weatherd by again, prior to arrival exhausting travel modalities  Mission assignment pending  You wait...  Relocated to an alternate  Just when you’ve begun to settle, 96hr location the journey continues  Mission begins  Faced with limited resources, long Week 1 hours, tough decisions, you work  Mission changes time again Week 2  Exhausted, dazed, and longing for a  Mission endsImage: FEMA Stock ID 54866 shower (hot or cold!) The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 31
    • 31. Practice Integration: Responder Focus ... filling gaps, overcoming challenges  On every deployment I encourage my team to focus on “controling the controlables”  This is accomplished by: • Taking care of one’s self, first “ cura te ipsum” • Next, taking care of one another • Lastly,taking care of our patients through difficult decision making on when, and when not, to advance care “ primum non nocere” • While not always overtly apparent, more often than not it’s not medical care we’re providing, but rather behavioral • Consequently, this is also an area where many responders are not familiarImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 32
    • 32. Practice Integration: Responder Focus Important considerations to accept, pre-disaster!  Team unity and support is critical to mission success  All disasters are different, and something new is learned on every deployment  You will be required to improvise, adjust, and operate outside of your comfort zone  Disasters require personnel to wear many diffferent hats  ”While I may be a physician in my day-to-day practice, when my boots hit the ground I will be a shoulder to cry on, a pharmacist, a nurse, a tech, a transporter, and a grunt moving resources.”– DMAT NJ-1 Medical Officer  Disaster responders and providers are forced to make difficult decisions  Knowing, deciding, and accpeting when to provide care (e.g. Haiti)  Disasters are physically, socially, mentally, psychologically, and spirtually draining  Down-time reading a book or listening to some tunes is a must  What can go wrong, will go wrongImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 33
    • 33. Practice Integration: Responder Focus “I personally havent saved a lot of lives in disasters... … but Ive given a lot of hugs and held a lot of hands.” Christina Catlett, MD, FACEP Medical Officer, MD-1 DMAT Director, Johns Hokpins Go Team MRCImage: FEMA Stock ID 54866 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 34
    • 34. Practice Integration: “Whole Community” Integrating Disaster Behavioral Health (DBH) Dynamically across the “Whole Community” – Survivors – Responders – Providers – Animals Survivors Responders Providers Animals Survivors S-S R-S P-S A-S Responders S-R R-R P-R A-R Providers S-P R-P P-P A-P Animals S-A R-A P-A A-A The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 35
    • 35. Practice Integration: Information Technology & Mobility Health Information Technology (HIT) Health Information Exchange (HIE) The use information technology and mobility in the disaster response is here. The time for Public Health and Behavioral Health Disaster Response to get involved is now. Southeast Regional HIT-HIE Collaboration (SEARCH): Final Report, ONC State Health Policy Consortium Project: Health Information Exchange in Disaster Preparedness and Response, July 2012 http://www.healthit.gov/sites/default/files/pdf/SERCH-White-Paper.pdf The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 36
    • 36. Practice Integration: HIE in Disaster Preparedness & Response:Five Recommendations for State HIEs (1) Understand the State’s disaster response policies and align with the State agency designated for Emergency Support Function #8 (Public Health and Medical Services) before a disaster occurs. (2) Develop standard procedures approved by relevant public and private stakeholders to share electronic health information across State lines before a disaster occurs. (3) Consider enacting the Mutual Aid Memorandum of Understanding to establish a waiver of liability for the release of records when an emergency is declared and to default state privacy and security laws to existing Health Insurance Portability and Accountability Act (HIPAA) rules in a disaster. States should also consider using the Data Use and Reciprocal Support Agreement (DURSA) in order to address and/or expedite patient privacy, security, and health data-sharing concerns. (4) Assess the State’s availability of public and private health information sources and the ability to electronically share the data using HIE(s) and other health data- sharing entities. (5) Consider a phased approach to establishing interstate electronic health information- sharing capabilities. Source: Southeast Regional HIT-HIE Collaboration (SEARCH): Final Report, ONC State Health Policy Consortium Project: Health Information Exchange in Disaster Preparedness and Response, July 2012, http://www.healthit.gov/sites/default/files/pdf/SERCH-White-Paper.pdf The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 37
    • 37. Practice Integration: Health Information Exchange • Patient Admission • Patient Discharge Notification Examples • New Laboratory Result • New Radiology Result • Final Microbiology • ER Admission The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 38
    • 38. Presentation Snap-Shot Presenter Disclosure Disaster Behavioral Health The Perfect Plan Practice Integration Wrap-up The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 39
    • 39. Wrap-up Disaster Behavioral Health: a public health practice The Perfect Plan: knowing what to use; when to use it; how to use it Practice Integration: responder focus Practice Integration: the “whole community” Practice Integration: Health Information Technology (HIT) and Health Information Exchange (HIE)Image: FEMA Stock ID 33425 The information contained in this document is proprietary. Copyright © 2012 Capgemini. All rights reserved. 40
    • 40. Anthony A. Barone | M.P.H. | CHMM | CHS-V | FF/EMT-BSenior Consultant | Public SectorCapgemini Government Solutionsanthony.barone@capgemini-gs.com www.capgemini-gs.com The information contained in this presentation is proprietary. © 2012 Capgemini. All rights reserved.
    • 41. About CapgeminiWith around 120,000 people in 40 countries, Capgemini isone of the worlds foremost providers of consulting,technology and outsourcing services. The Group reported2011 global revenues of EUR 9.7 billion (approximately$13.5 billion USD).Together with its clients, Capgemini creates and deliversbusiness and technology solutions that fit their needs anddrive the results they want. A deeply multiculturalorganization, Capgemini has developed its own way ofworking, the Collaborative Business ExperienceTM, anddraws on Rightshore ®, its worldwide delivery model.Rightshore® is a trademark belonging to Capgemini www.capgemini-gs.com The information contained in this presentation is proprietary. © 2012 Capgemini. All rights reserved.