Anthony Speier

Factors Contributing to Mental and Physical Health Care in a Disaster-Prone Environment.

Environment as a contextual factor plays an important role in southeastern Louisiana, as this area represents a major economic hub for the United States port, petroleum, and fishing industries. The location also exposes the population to both natural and technological disasters, including Hurricane Katrina and the Gulf oil spill. This study explored associations among hurricane loss, oil spill disruption, and environmental quality of life on mental and physical health on over 1,000 residents (N = 1,225) using structural equation modeling techniques. Results showed that oil spill distress was associated with increased symptoms of mental and physical health; Hurricane Katrina loss; and decreased environmental quality of life. Findings also indicate that mental health symptoms explain the association among oil spill distress and physical health symptoms—specifically, those that overlap with somatic complaints. These findings provide important support of the need for mental health assessment and service availability for disaster recovery.

Disaster behavioral health: legal and ethical considerations in a rapidly changing field

Disaster behavioral health is increasingly regarded as a central part of disaster preparedness, response and recovery. Legal and ethical issues have received relatively little attention and have sparked divergent opinions. Optimally, understanding and applying legal and ethical considerations requires an understanding of the evolution of the disaster behavioral health field and the context of disaster response and recovery. In addition, there are many legal and ethical questions identified for consideration, and many ways to approach reaching understanding and consensus. Traditionally, discussions of disaster behavioral health, including legal and ethical issues, have not included understanding decision making processes that occur in extreme circumstances. Models which interpret disaster response operations as complex adaptive systems are presented for consideration as useful tools for preparing mental health workers for effectively delivering services in acute disaster response environments.

Gulf Coast Resilience Coalition: An Evolved Collaborative Built on Shared Disaster Experiences, Response, and Future Preparedness

OBJECTIVE For close to a decade, the Gulf Coast of the United States has been in almost constant disaster recovery mode, and a number of lessons have been learned concerning disaster recovery and behavioral health. The purpose of this report was to describe the natural development of a Gulf Coast Resilience Coalition (GCRC). METHODS The GCRC methods began with state-specific recovery goals following Hurricane Katrina in 2005 and transitioned to a shared multistate and multidiscipline coalition. The coalitions effectiveness is demonstrated through continuation, procurement of funding to provide response services, and increased membership to ensure sustainability. RESULTS The coalition has enhanced response, recovery, and resilience by providing strategic plans for dissemination of knowledge; post-disaster surveillance and services; effective relationships and communication with local, state, and regional partners; disaster response informed by past experience; a network of professionals and community residents; and the ability to improve access to and efficiency of future behavioral health coordination through an organized response. CONCLUSIONS The GCRC can not only improve readiness and response, but work toward a shared vision of improved overall mental and behavioral health and thus resilience, with beneficial implications for the Gulf South and other communities as well.

Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster.

Introduction: Addressing life stressors is an important function for integrated care, especially for health care homes located in disaster prone environments. This study evaluated trajectories of change for patients with postdisaster posttraumatic stress disorder (PTSD) who were seen in integrated care. In addition to describing the results, this article provides the methods of subgroup analyses as this may be useful for others working in real-world practice. Method: Patients (N = 340) receiving services at 5 rural health clinics self-reported PTSD symptoms as part of an ongoing evaluation to study the effectiveness of integrated health. Analysis of variance was used to assess differences overtime and trajectories were identified with cluster analyses. Disaster and trauma related factors associated with these trajectories were assessed using logistic regression. Results: Significant overall decreases in PTSD symptoms overtime were found; individual trajectories were identified and include stable low, steep declines, stable high symptoms, and increasing symptoms. Stress related to disaster and the number of other traumas patients experienced correctly classified trajectory membership. Discussion: Trajectories indicate that patients have differing treatment needs and cluster analysis as an evaluation technique may be useful in identifying what treatment works and for whom. The present study addresses a major concern for health care providers serving disaster prone communities and emphasizes the importance of identifying pre incident and disaster related risk vulnerabilities that contribute to mental health outcomes. Subgroup analyses are a useful tool for developing more targeted treatment within integrated care and may be an accessible research strategy for others working in such settings.

Collaborative Health Care and Emerging Trends in a Community-Based Psychiatry Residency Model.

ObjectiveThis paper provides a report of an academic department of psychiatry’s journey into the change process associated with addressing the new requirements in health-care delivery, the emphasis on person-centered treatment models, and the implications for residency training programs. Louisiana State University Health Sciences Center Department of Psychiatry’s experience is based on responding to real-world shifts in which academic departments can play a leadership role.MethodsImportantly, methods are based on person-centered collaboration being central to a successful change process and include a description of the training, with data supporting implementation of the model.ResultsThe model demonstrates increased access to care and improved behavioral health symptoms. It indicates that with proper training and supervision, psychiatry residents can be an agent of change.ConclusionThis brief review of our experience offers to other departments of psychiatry examples of collaborative strategies substantially informed by the needs and preferences of both persons accessing services and local communities.

Building a Disaster Mental Health Response to a Catastrophic Event: Louisiana and Hurricane Katrina

The psychological impact of a catastrophic event is complex and is often not well understood by either response personnel or persons directly impacted by the incident. Catastrophic events by their very nature are outside of normal experience and thus, their psychological force is often miscalculated. This miscalculation can directly influence how behavioral health personnel are utilized in disaster response operations. This chapter examines the preparation for natural disasters (hurricanes) in Louisiana since 1992 (Hurricane Andrew) through the more recent emergency planning and response activities associated with Hurricane Katrina. The role of behavioral health agencies and professionals in becoming an integral component of the emergency response infrastructure is examined within the context of the Hurricane Katrina emergency response operations. Our experience delivering crisis interventions services to first responders, children, and survivors in a variety of settings underscores the importance of preparing behavioral health workers with the skills for utilizing standard crisis response protocols including the ability to recognize the symptoms of psychological trauma. Behavioral health disaster operations planning represents an ongoing strategy which is now emerging as a core component of state and national planning, response, and deployment tactics.

Building Resilience after Disasters through the Youth Leadership Program: The Importance of Community and Academic Partnerships on Youth Outcomes

• The Youth Leadership Program is a school, community, and university partnership designed to better understand the concept of personal resilience and overcoming the mental and emotional components of extreme events such as hurricanes. • Describe the program and how it was effective in helping youth and communities recover from the most costly hurricane in the history of the United States. • The current project examined the role of positive activities in school and community settings. • The importance of leadership through action, as a feature of resilience for personal recovery, begins with engagement of youth. • Describe and demonstrate features of self-efficacy, and its positive influence on leadership skills, because studying trauma symptoms alone is only part of the recovery equation.

Why Is Integrating Emergency Management Essential to Disaster Behavioral Health? Challenges and Opportunities

This chapter addresses why disaster behavioral health (DBH) needs integration with emergency management (EM). All actions in every phase are becoming increasingly formalized and just as in professional sports, nobody plays without not only understanding who owns the team but also agreeing to the owner’s contract. Basically, in order for DBH to do their jobs they must understand the structure and agree to play by EM rules and within EM structures. Those in all specialty fields need to know this and DBH is no exception. The authors explain, through real examples, how DBH practitioners can benefit from the access, information and support that EM can offer.

Integrated Mental and Behavioral Health Services to Improve Patient Outcomes and Clinical Care

ABSTRACT This presentation will focus on the importance of addressing mental health in the overall response to the Deepwater Horizon Oil Spill. Emphasis will be placed on evidence based, integrated...