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In 2000, the Centers for Disease Control and Prevention (CDC) and the Association of Schools of Public Health (ASPH) established the Centers for Public Health Preparedness (CPHP) to educate and train the public health workforce to prepare and respond to acts of domestic terrorism, as well as other disasters that might threaten the public health and welfare of the U.S. To facilitate this developmental process, CDC and ASPH established content-specific inter-CPHP committees referred to as “exemplar groups.” In 2004, CDC and ASPH directed CPHP network members to create the CPHP Mental Health and Psychosocial Preparedness Exemplar Group to address the mental health aspects of terrorism and mass disasters.
Terrorism has been defined as “… an attack on the mental health of a nation.”1 More broadly, however, disaster mental health and psychosocial preparedness are essential and integral components of any comprehensive disaster preparedness and response plan, as there is invariably a psychological toll associated with every major disaster.2,3 Public health and other disaster health-care workers need to be aware of the behavioral, mental, and psychosocial sequelae of disasters, as well as the approaches needed to assess and offer assistance during every phase of a disaster.4 Yet disaster plans and disaster training, with some notable exceptions, have often ignored mental health and psychosocial preparedness.2
The Mental Health and Psychosocial Preparedness Exemplar Group drew CPHP network members who possessed relevant subject matter expertise. This group developed a charter, compiled relevant CPHP training materials, developed an objective review template, and collectively assembled and reviewed the resources. Reviews were presented at a consensus meeting in Atlanta, Georgia, in March 2005, where an asset matrix was developed to compare and categorize the training and education curricula and resources. The group's report was completed in September 2005, with a subsequent publication of findings.5
One of the group's constituent recommendations for further development was to create a list of core disaster mental health competencies designed to augment the Columbia Core Public Health Worker Competencies for Emergency Preparedness and Response.6 This was driven in part by a lack of generally agreed-upon disaster mental health competencies that could serve to guide training for disaster response personnel. The conceptual foundations for such a translation have already been undertaken.7 Furthermore, the data suggest that the level of responder training in crisis intervention is positively related to psychological outcomes of disaster victims.8,9 By identifying disaster mental health competencies and providing training that reflects these competencies, it is anticipated that the public health workforce will be better equipped to prepare for and respond to the psychological needs of disaster survivors.
The CPHP Mental Health and Psychosocial Preparedness Exemplar Group was transitioned into the Disaster Mental Health Collaborative Group (DMHCG) in 2006. Collaborative group membership included the following participants: Randal D. Beaton (University of Washington School of Public Health, Northwest Center for Public Health Practice), George S. Everly, Jr. (The Johns Hopkins Center for Public Health Preparedness), Nancy Fiedler (University of Medicine and Dentistry of New Jersey School of Public Health, New Jersey Center for Public Health Preparedness), Dawn Gentsch (University of Iowa College of Public Health Upper Midwest Center for Public Health Preparedness), Melanie Livet (University of South Carolina Arnold School of Public Health Center for Public Health Preparedness), Paula Madrid (Columbia University Mailman School of Public Health, Center for Public Health Preparedness), Nadine D. Mescia (University of South Florida College of Public Health, Florida Center for Public Health Preparedness), Cindy Parker (The Johns Hopkins Center for Public Health Preparedness), Betty Pfefferbaum (University of Oklahoma Health Sciences Center, Southwest Center for Public Health Preparedness), and James M. Shultz (University of Miami School of Medicine, Center for Hispanic Disaster Training). Dr. Beaton was the chair of this collaborative group and cochaired the development of mental health competencies with Dr. Everly. Dr. Dori Reissman was the expert representative from CDC. The process was coordinated by Kalpana Ramiah and Beth Rada of ASPH. DMHCG's mission was to develop a consensus set of core competencies in disaster mental health. The group would similarly initiate development of and/or highlight resources for skills-based/experiential training programs.
Once the DMHCG had created the consensus core competencies, a process of vetting was to be undertaken. Explicit in the vetting process was the intention to share the consensus recommendations with potential public health practice partners at the local level, with select governmental and nongovernmental agencies that might share interest in the recommendations, and with public health scholars. As a means to that end, this article describes the processes and outcomes to date of the CPHP DMHCG, including the purpose/rationale for this undertaking and the resultant proposed core competencies in disaster mental health.
The DMHCG convened via twice-monthly telephone conferences in December of 2005, and January and February of 2006. The subgroup responsible for developing the core disaster mental health competencies met in Atlanta in late March 2006. An initial draft set of core competencies was generated at that meeting. Further collaborative refinement was undertaken via frequent telephone and e-mail correspondence until a final set of proposed competencies was agreed upon in May 2006. The proposed set of competencies was presented to and accepted by the remaining DMHCG members via e-mail and during an in-person meeting held in Washington, DC, in May 2006.
The consensus document containing five core competencies in disaster mental health is presented within this section. The specific competencies themselves are prefaced by a seven-point preamble that serves as a platform for the understanding and practice of the competencies themselves.
The following represents the consensus core competencies for disaster mental, psychosocial, and behavioral health preparedness and response. These competencies can serve as a framework for developing training programs, educational curricula, evaluation processes, and organizational and human development initiatives, such as job descriptions and performance evaluations. These competencies must be integrated within organizational structure and incident management systems and are guided by the following principles.
This article illustrates the development of a set of proposed core competencies in disaster mental health. While the primary target audience is public health and disaster assistance personnel, we believe the competencies, in the aggregate, may serve as useful guidance for any and all disaster response personnel. More specifically, such guidance might prove useful in selecting individuals for deployment to perform disaster mental health functions during and after a disaster. Furthermore, such guidance might prove useful in developing training programs designed to prepare public health and other personnel to perform disaster mental health functions in the field.
These core competencies should be viewed as foundational. The DMHCG recognizes that a set of more advanced competencies is requisite and, when developed, will be built upon the extant core competencies and will address specialized interventions designed to meet the needs of specialized subgroups and uniquely challenging situations.
This article was supported by Cooperative Agreement #U90/CCU324236-02 from the Centers for Disease Control and Prevention (CDC). The contents of this article do not necessarily represent the official views of CDC.