Preparing for the Psychological Consequences of Terrorism A Public Health Strategy (2003) / Chapter Skim
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3. Current Infrastructure in the United States for Responding to the Psychological Consequences of Terrorism
3. Current Infrastructure in the United States for Responding to the Psychological Consequences of Terrorism
Pages 64-98
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From page 64... ...
Surveillance for psychological consequences, including distress responses, behavior changes, and psychiatric illness, and markers of individual and community functioning before, during, and after a terrorism event 4. Screening of psychological symptoms at the individual level Treatment for acute and long-term effects of trauma 6.
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From page 65... ...
The federal government will provide assistance on an as-needed basis for declared emergencies or major disasters that overwhelm local capacity as outlined in the Federal Response Plan .~ The Federal Emergency Management Agency ~ As described below, the Department of Homeland Security is currently in the process of consolidating the Federal Response Plan and other response plans into an all-hazard National Response Plan.
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From page 66... ...
Federal Response Plan The response of the federal government to a major emergency situation is dictated by the Federal Response Plan (FRP) , which is designed to coordinate the efforts of 27 federal departments and agencies and the Red
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From page 67... ...
SAMHSA provides these functions primarily through the Crisis Counseling Assistance and Training Programs, which are described in the following section. The ESF 6, mass care, is led by the American Red Cross.
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From page 68... ...
A regular services grant must be applied for within 60 days of the disaster declaration; it funds an additional nine months of crisis counseling programs. Services provided under the CCP include education and counseling, community outreach, individual crisis counseling, and referral services.
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From page 69... ...
NCTSN was also active in responding to psychological needs after the September 11, 2001, terrorist attacks, providing mental health services, consultation, training, research services, and public education. SAMHSA's Emergency Services and Disaster Relief Branch of CMHS, in collaboration with the National Center for Post-Traumatic Stress Disorder of the Department of Veterans' Affairs, has undertaken a multiyear project called the National Crisis Response Technical Assistance Project.
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From page 70... ...
The CDC has agent-specific communication response plans prepared in order to facilitate rapid utilization in the event of a biological, chemical, or radiological terrorist attack. These resources within the CDC function to train and assist local authorities in risk communication; in general, the risk communications activities that follow a disaster or terrorism event are performed by local government and public health authorities.
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From page 71... ...
Ongoing efforts by the Department of Education have focused on developing a model school crisis plan, for comparison by schools to their own plans, thus streamlining the entire development process. Additionally, the Department of Education has encouraged school districts to strengthen and reevaluate their crisis plans in light of potential terrorism events and has made available $30 million in discretionary grants to assist school districts in these activities (U.S.
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From page 72... ...
The new department is a major reorganization of the federal government in the United States, bringing together under its authority a number of existing federal agencies. The stated mission of the Department of Homeland Security is to prevent terrorist attacks, reduce vulnerability to terrorism, and minimize damage and promote recovery from terrorist attacks.
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From page 73... ...
It describes specific actions to take in the event of different types of terrorist attacks, such as "sheltering-in-place" if there is air contamination, and recommends components of emergency supply kits, including such items as clean water, flashlights, first-aid supplies, and extra prescription medications. Department of Justice The Department of fustice's Office for Victims of Crime (OVC)
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From page 74... ...
It operates the Antiterrorism and Emergency Assistance Program, which provides information, identifies resources, administers various compensation programs, and advances training and educational programs for groups such as emergency responders and mental health providers. In response to the September 11, 2001, terrorist attacks, this program, among other activities, supported crisis counseling provided through CMHS.
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From page 75... ...
In response to this designation, the Red Cross created the Aviation Incident Response (AIR) team, an interdisciplinary group of disaster experts that advises the Red Cross on issues unique to aviation and other transportation disasters and leads the Red Cross disaster response in these instances.
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From page 76... ...
The state and local infrastructure is vital to effective response, given the local and regional nature of recent terrorism events. The Oklahoma City bombing was mostly local, while the 2001 Anthrax attacks and September 2001 air attacks were largely regional events.
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From page 77... ...
In practice, much of the immediate and short-term state disaster mental health response is conducted through routine community mental health services. In the event of a presidentially declared disaster, funding streams from the FEMA/SAMHSA Crisis Counseling Assistance and Training Program (CCP)
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From page 78... ...
Many states have agreements with bordering states to activate reciprocal licensing for all health professionals in the event of a disaster. Also, some states stipulate that health professionals working under the auspices of the Red Cross are automatically permitted to practice within the context of the disaster response.
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From page 79... ...
In response to each of these events, the county school system provided supportive counseling to more than 139,000 students and 20,000 staff members (Mintz, 2003~. PRIVATE SECTOR SYSTEMS FOR RESPONSE Private sector systems for response include a variety of groups ranging from the American Red Cross, to university departments of psychology, to individual religious groups and charities.
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From page 80... ...
The program also provides mental health-related services and resources to disaster survivors, other disaster-relief workers, and families of Red Cross disaster responders (American Red Cross, 1998~. The FRP identifies the Red Cross as a support agency whose duties regarding psychological responses are specified as including the provision of supportive counseling to disaster survivors and family members of victims.
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From page 81... ...
The outbreak of Foot and Mouth Disease in the United Kingdom in 2001, while not a terrorism event, resulted in significant economic loses, which had psychological consequences for those affected (Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, 2002~. It is reasonable to assume that the psychological ramifications are a potential risk in the event of an attack involving
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From page 82... ...
One of the organization's initiatives, "Mental Health and Primary Care in a Time of Terrorism," will assess the experiences and needs of primary care providers dealing with mental health problems, develop and disseminate education tools designed to help them, and assess the effectiveness of these tools in light of new knowledge about the nature of mental health responses to terrorism and bioterrorism (America's HealthTogether, 2003~. The Department of Defense used the primary care setting as an entry point for mental health care in its response to the September 11, 2001, attack on the Pentagon called Operation Solace.
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From page 83... ...
team that is responsible for coordinating local spiritual care volunteers in the event of an aviation disaster. Working with the AIR team and the rest of the Red Cross, the SAIR team provides emotional and spiritual support to survivors, families, rescue workers, and airline personnel.
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From page 84... ...
There is a general consensus among the public health and disaster mental health community that the infrastructure designed to promote and protect the public's health is inadequate to respond to psychological needs after a terrorism event of great magnitude or uniqueness. The best tests of the capacity of the nation's systems have come from the two largest terrorism events occurring in the United States in the recent past: the Oklahoma City bombing and the September 11, 2001, attacks.
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From page 85... ...
These funds were used to establish Project Heartland, a public mental health program to provide crisis counseling, outreach, education, and referrals as dictated by the CCP. The ODMHSAS provided oversight during the transition from the immediate crisis services provided by the Red Cross at the Compassion Center to the ongoing activities of Project Heart
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From page 86... ...
This may have been related to a lack of established relationships with providers, and the limitations of funding for such care. In recognition of these limitations, the American Red Cross funded long-term treatment for individuals through the Sunbridge Counseling Program, operated by the Mental Health Association of Oklahoma County.
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From page 87... ...
Complex responses took place in New York City and the Washington, D.C., metropolitan area; this section focuses on those responses as illustrative examples. Responses in New York City During the immediate postimpact period, as in the Oklahoma City bombing, much of the response to meet psychological and emotional needs of families, survivors, and rescue workers in New York City was managed by the American Red Cross.
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From page 88... ...
The American Red Cross and the September 11th Fund (a charitable foundation established on the day of the attacks to assist survivors) implemented a program to provide reimbursement for long-term mental health care including psychotherapy, hospital care, medication, and substance abuse programs for family members of victims, people injured in the attacks, or residents of lower Manhattan who were displaced due to the attacks (September 11th Fund, 2003~.
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From page 89... ...
As with the response in New York City, the Red Cross played a central role in the provision of services immediately after the attack to both survivors and emergency responders. The immediate response by the Red Cross was managed by local Red Cross leaders; national-level leaders assumed leadership for the response once they were able to get to the area (closure of all area airports hindered their ability to reach the scene)
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From page 90... ...
This program was based in part on the experiences of Project Heartland in Oklahoma City and focused on four different levels of intervention: community, unit or workplace, primary care, and specialty mental health clinics (Hoge et al., 2002~. It was characterized by direct outreach both in the workplace and in primary care visits, during which individuals thought to have possible psychological consequences were referred for further care.
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From page 91... ...
A central weakness in the response to the September 11, 2001, terrorist attack on the Pentagon was related to issues of command structure and communication among the different agencies and individuals responding. Although many services were provided, the efficiency and effectiveness of response were hindered by the lack of a central contact point to direct the response; inadequate communication between and among civilian and military agencies contributed to parallel services and duplication of efforts (Metropolitan Washington Mental Health Community Response Coalition, 2002~.
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From page 92... ...
A lack of counseling services to address anxiety and fear in individuals who went to testing centers but were not given prophylactic treatment has been noted as a weakness in the response to the psychological consequences of the anthrax attacks (Metropolitan Washington Mental Health Community Response Coalition, 2002~. Concerned members of the public overwhelmed the resources of public health departments throughout the country.
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From page 93... ...
Red Cross Disaster Mental Health Services providers are required to be licensed, and other volunteers often have training and credentials but may not have licensure in the states where a disaster occurs. The practice in NDMS, in which
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From page 94... ...
Public Communication and Dissemination of Information Communication activities are especially problematic in the area of pre-event public education; because this type of intervention must occur prior to an event, it cannot be made part of disaster response plans. Communication will also be essential during and after chemical, biological, radiological, and nuclear terrorism events.
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From page 95... ...
The provision of care in Oklahoma City continued for a number of years with support from foundations, charities, and the American Red Cross. Special provisions have similarly been made for the World Trade Center to extend the period of funding for care.
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From page 96... ...
· The psychological impact of a terrorist attack with weapons of mass destruction remains largely unknown, and current response capabilities for such an event are likely to be inadequate. SUMMARY Although a variety of programs and services are in place to respond to psychological issues in a crisis or disaster, issues regarding the coordination of agencies, organizations, and services; training and supervision of providers; communication and dissemination of information; financing of services; and lack of an evidence base to direct these services pose
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From page 97... ...
Finding 3-1: Many mental health professionals do not have specific knowledge with regard to disaster mental health. Training and education emphasizing psychological consequences and methods for response should be provided to professionals within mental health fields, including school-based mental health practitioners such as school counselors, school psychologists, and school social workers.
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From page 98... ...
Recent terrorism events have created new workplaces and categories of responders and have exposed traditional first responders to new levels of job-related stress and risk. Finding 3-4: Research following terrorism events presents a multitude of practical and ethical challenges.
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