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Public Health Rep. 2008 Jul-Aug; 123(4): 539–542.
PMCID: PMC2430653

TRAINING FOR DISASTER RESPONSE PERSONNEL: THE DEVELOPMENT OF PROPOSED CORE COMPETENCIES IN DISASTER MENTAL HEALTH

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.

CURRENT PROJECT MISSION

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 DEVELOPMENT PROCESS

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.

COMPETENCIES OVERVIEW

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.

Preamble

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.

  • Adherence to performance within one's scope of practice (e.g., functional role; knowledge, skill, and authority; continuing education; ethics; licensure; certification) with respect to individuals, families, groups, organizations, and/or at the population level.
  • Consideration of the context of the situation (e.g., event type, population served, geography, sensitivity for unique subgroup needs) in applying these competencies.
  • Recognition of the distinction between public health initiatives and clinical practice with respect to the population, temporal acuity, and disaster phase; and a further distinction between crisis intervention and traditional mental health treatment.
  • Sensitivity to diversity and cultural competence.
  • Acceptance of management/leadership to recognize and embrace disaster behavioral health principles.
  • Recognition of the desire to reduce the risk of any harm that may come from intervention.
  • Recognition of the importance of teamwork and adherence to the incident command system.

CONSENSUS CORE COMPETENCIES IN DISASTER MENTAL HEALTH

  1. Disaster response personnel will demonstrate the ability to define and/or describe the following key terms and concepts related to disaster mental/psychosocial/behavioral health preparedness and response:
    1. The biopsychosocial and cultural manifestations of human stress.
    2. Phases of psychosocial disaster and recovery reactions at the community level.
    3. The effects of psychological trauma and disaster-related losses and hardships.
    4. Incident management structure and the role of disaster mental health in a multidisciplinary disaster response.
    5. Disaster mental health intervention principles.
    6. Crisis intervention(s) with disaster-affected individuals.
    7. Population-based responses before, during, and after a disaster (e.g., evacuation, shelter in place).
  2. Disaster response personnel will demonstrate the following skills needed to communicate effectively:
    1. Establish rapport.
    2. Employ active/reflective listening skills.
    3. Display effective nonverbal communications.
    4. Establish realistic boundaries and expectations for the interaction.
    5. Use a culturally competent and developmentally appropriate manner of communication.
  3. Disaster response personnel will demonstrate skill in assessing the need for, and type of, intervention (if any) including, but not limited to, the ability to:
    1. Gather information by employing methods such as observation, self-report, other reports, and other assessments.
    2. Identify immediate medical needs, if any.
    3. Identify basic human needs (e.g., food, clothing, shelter).
    4. Identify social and emotional needs.
    5. Determine level of functionality (e.g., the ability to care for self and others, follow medical advice and safety orders).
    6. Recognize mild psychological and behavioral distress reactions and distinguish them from potentially incapacitating reactions.
    7. Synthesize assessment information.
  4. Disaster response personnel will demonstrate skill in developing and implementing an action plan (based upon one's knowledge, skill, authority, and functional role) to meet those needs identified through assessment including, but not limited to the following behaviors:
    1. Disaster response personnel will demonstrate skill in developing an action plan including the ability to: (1) identify available resources (e.g., food, shelter, medical, transportation, crisis intervention services, local counseling services, financial resources), (2) identify appropriate stress management interventions, and (3) formulate an action plan consisting of sequential steps.
    2. Disaster response personnel will demonstrate skill in initiating an action plan including the ability to: (1) provide appropriate stress management, if indicated, (2) connect to available resources (e.g., food, shelter, medical, transportation, crisis intervention services, local counseling services, financial resources), (3) connect to natural support systems (e.g., family, friends, coworkers, spiritual support), and (4) implement other interventions as appropriate.
    3. Disaster response personnel will demonstrate the ability to evaluate the effectiveness of an action plan considering changes in situation or disaster phase through methods such as observation, self-report, other reports, and other assessments.
    4. Disaster response personnel will demonstrate the ability to revise an action plan as needed (e.g., track progress and outcomes).
  5. Disaster response personnel will demonstrate skill in caring for responder peers and self including, but not limited to the ability to:
    1. Describe peer-care techniques (e.g., buddy system, informal town meetings).
    2. Describe self-care techniques (e.g., stress management, journaling, communication with significant others, proper exercise, proper nutrition, programmed downtime, sufficient quality sleep).
    3. Describe organizational interventions that reduce job stress (e.g., organizational briefings, adjustment of shift work, job rotations, location rotations, effective and empathic leadership, work/rest/nourishment cycles, and support services, as indicated).

CONCLUSION

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.

Footnotes

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.

REFERENCES

1. Clark L. The costs of terror: mental and physical health. the First Annual International Conference on Living with Terror: Psycho-Social Effects; 2004 Jun 28; Washington. Presented at.
2. Department of Health and Human Services (US) Rockville (MD): Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; 2003. Mental health all-hazards disaster planning guidance. DHHS Pub. No. SMA 3829.
3. Drayer CS, Cameron DC, Woodward WD, Glass AJ. Psychological first aid in community disaster. J Am Med Assoc. 1954;156:36–41. [PubMed]
4. Everly GS, Jr, Barnett D, Parker CL. Attempting to predict “surge:” a review of the mental health consequences of terrorism in the United States. Baltimore: The Johns Hopkins Center for Public Health Preparedness; 2005.
5. Hoffman Y, Everly GS, Jr, Werner D, Livet M, Madrid PA, Pfefferbaum B, et al. Identification and evaluation of mental health and psychosocial preparedness resources from the centers for public health preparedness. J Public Health Manag Pract. 2005;(Suppl):S138–42. [PubMed]
6. Center for Health Policy, Columbia University School of Nursing. Core public health worker competencies for emergency preparedness and response. 2001. [cited 2008 Feb 24]. Available from: URL: http://www.doh.state.fl.us/chdCharlotte/documents/Competencies.pdf.
7. Parker CL, Barnett DJ, Everly GS, Jr, Links JM. Expanding disaster mental health response: a conceptual training framework for public health professionals. Int J Emerg Ment Health. 2006;8:101–9. [PubMed]
8. Preliminary results from the World Trade Center evacuation study—New York City, 2003. MMWR Morb Mortal Wkly Rep. 2004;53(35):815–7. [PubMed]
9. Stapleton AB, Lating J, Kirkhart M, Everly GS., Jr Effects of medical crisis intervention on anxiety, depression, and posttraumatic stress symptoms: a meta-analysis. Psychiatric Q. 2006;77:231–8. [PubMed]

Articles from Public Health Reports are provided here courtesy of SAGE Publications