Disaster Mental Health Surveillance Assessment at State Agencies

Transcription

1 Disaster Mental Health Surveillance Assessment at State Agencies CSTE Disaster Epidemiology Workshop May 8, 2013 Atlanta, Georgia Deborah W. Gould, PhD Senior Public Health Advisor Division of Behavioral Surveillance Centers for Disease Control and Prevention Michael Heumann CSTE Consultant Erin F. Simms, MPH CSTE Office of Surveillance, Epidemiology, and Laboratory Services Public Health Surveillance and Informatics Program Office

2 Disaster MH Surveillance Examples of MH Responses to Disasters Distress Response Change in sleep Uncertainty Grief Fear Anger/violence PTSD Depression Generalized Anxiety Mental Illness Health Risk Behaviors Substance abuse Smoking Self medicating Physical inactivity Center for the Study of Traumatic Stress

3 Disaster MH Surveillance Surveillance data is pivotal for understanding MH consequences of disasters. CDC s and States MH response efforts are challenged by limitations in existing surveillance assets, data, and collection methods. For example: MH surveillance not part of core PH surveillance Compartmentalization of MH and PH at state and local levels Limited baseline data Lack of standardized MH surveillance protocols Interpretation and dissemination of MH surveillance data Need better integration of PH with MH following disasters

4 Disaster MH Surveillance: CDC & CSTE CDC & CSTE collaborated to conduct a needs assessment with state epidemiologists to explore: The nature of relations between state epidemiologists and mental health personnel during a response Use of existing MH surveillance systems MH surveillance needs and priorities during a response How state epidemiologists use MH surveillance data in the context of disaster response Barriers to use Other pertinent issues related to mental health surveillance in the context of disaster response.

5 Methods July September 2012: Five focus groups/conference calls conducted with several State Epis to help inform the topics for a web-based assessment survey. December 2012: Pilot assessment administered in 3 states and then revised based on feedback February 2013: Final web-based assessment (SurveyMonkey) sent to the State Epi in all 50 States and D.C. Included 36 questions covering 5 main topic areas: 1. Background relations (between PH and MH, outside of any disaster or planning) 2. Disaster preparedness planning (as they relate to PH and MH) 3. Disaster response (assessing MH needs, participation in EOC, AOC) 4. Disaster recovery (long-term post-disaster MH needs) 5. After Action/Hot-wash

6 Results: Background Relations 41 out of 51 jurisdictions completed the assessment (80% Response Rate) Survey respondent affiliation: Affiliation Number (%) Epidemiologist 24 (59) State Epidemiologist 15 (37) Other Epidemiologist 9 (22) Emergency Preparedness 10 (24) Behavioral Health (BH) 5 (12) BH Coordinator 1 (2) Disaster-related BH 4 (10) Social Worker 2 (5) Total 41 (100)

7 Results: Background Relations What is the affiliation between PH and MH in your state? Affiliation Number (%) PH and MH in different department or agencies 24 (59) PH and MH in same department or agency, BUT in a separate division 13 (32) PH and MH in same department or agency and same division 2 (5) Don t know 1 (2) Other 1 (2) Total 41 (100)

8 Results: Background Relations What is the level of collaboration between PH and MH in your state? Level Number (%) Frequent 12 (29) Some 21 (51) Minimal 7 (17) None 1 (2) Total 41 (100)

9 Results: Background Relations How are MH data from Federal surveillance systems (e.g. BRFSS, NHANES, NHIS, NSDUH, etc.) currently used in your state? Type of use Number (%) Baseline prevalence of MH 28 (68) For policy, planning, or decision-making 23 (56) To determine the need for MH services 22 (54) Identify vulnerable populations based on use of MH services 19 (46) For funding projections 16 (39) Don t know 8 (20) Other 6 (15) Missing response 1 (2) Total* 41 *Multiple responses allowed for this question. Total represents total number of respondents used as denominator for percentages.

10 Results: Background Relations In your opinion, should MH surveillance in your state be: Number (%) Integrated into existing state-based population survey (e.g. BRFSS ) 35 (85) Integrated into state and local level health surveys 31 (76) Integrated into existing national surveys (NHIS, NSDUH, 24 (59) etc.) A stand-alone survey 9 (22) Integrated into existing notifiable disease surveillance systems 8 (20) Total* 41 *Multiple responses allowed for this question. Total represents total number of respondents used as denominator for percentages.

11 Results: Background Relations What are the barriers to conducting MH surveillance in your state? Type of barrier Number (%) Funding 36 (88) Silos between MH and PH in the state 24 (59) Skillset of staff 18 (44) Lack of coordination between PH and MH in the state 16 (39) Lack of understanding/appreciation of MH within PH agency 15 (37) Lack of understanding/appreciation of surveillance within MH 12 (29) agency Other 10 (24) Total* 41 *Multiple responses allowed for this question. Total represents total number of respondents used as denominator for percentages.

12 Results: Disaster Preparedness Planning Does the written PH plan/protocol include MH surveillance following a disaster? Number (%) Yes 14 (34) No 22 (54) Don t know 4 (10) Missing response 1 (2) Total 41 (100)

13 Results: Disaster Preparedness Planning Does any of your epidemiology staff have MH training that could assist in MH surveillance during a disaster? Number (%) Yes 10 (24) No 23 (56) Don t know 8 (20) Total 41 (100)

14 Results: Disaster Response How are MH needs assessed during disaster response in your state? Number (%) Shelter surveillance 21 (51) Crisis counseling hotlines 18 (44) CASPER (Community Assessment for PH Emergency Response) 7 (17) Syndromic surveillance 4 (10) Morbidity forms (CDC) 1 (2) Web-based survey 1 (2) Telephone survey 0 (0) Mental health needs not assessed 4 (10) Don t know 6 (15) Other 21 (51) Total* 41 *Multiple responses allowed for this question. Total represents total number of respondents used as denominator for percentages.

15 Results: Disaster Response Does your state use a set of standardized MH questions as part of surveillance to assess MH needs following a disaster? Number (%) Yes 7 (17) No 24 (59) Don t know 9 (22) Missing response 1 (2) Total 41 (100)

16 Results: Disaster Response How important is it to assess changes in MH needs for services following a disaster? Number (%) Very important 34 (83) Somewhat importance 6 (15) Of little importance 0 (0) Not important 0 (0) Missing response 1 (2) Total 41 (100)

17 Results: Disaster Recovery Does your state have a system in place to be implemented during the recovery phase after a disaster to collect data on long term postdisaster community MH needs and including Yes No Don t know Type of monitoring n (%) n (%) n (%) Monitoring the delivery/efficacy of disaster community MH services implemented after the incident? 7 (17) 21 (51) 13 (32) Monitoring the population to identify new needs (e.g. late onset PTSD) that emerge in the later stage post disaster 6 (15) 21 (51) 14 (34)

18 Results: AAR/Hot-wash Do MH staff participate in the PH Hot-wash or AAR? Frequency Number Hot-wash (%) Number AAR (%) Yes, always 2 (5) 5 (12) Yes, mostly 9 (22) 8 (20) Yes, sometimes 9 (22) 8 (20) Yes, rarely 5 (12) 3 (7) No, not done 11 (27) 12 (29) Don t know 4 (10) 5 (12) Missing 1 (2) 41 (100) Total 41 (100) 41 (100)

19 Acknowledgement Project Workgroup Members Deborah Gould, CDC Denise Bulling, Univ. of Nebraska Amy Wolkin, CDC Jim Harvey, Nebraska Catherine (Katie) Okoro, CDC Hal Johnson, Florida Michael Heumann, CSTE Collette Young, Oregon consultant Erin Simms, CSTE David Zane, Texas Martha Stanbury, Michigan Chance Freeman, Texas Sharon Watkins, Florida Doug Thoroughman, Kentucky (CDC CEFO) Rachel Roisman, California Monika Eros-Sarnyai, New York City Pamela Holland, Maine Scott Sumrall, Mississippi

20 Discussion

21 Questions? Deborah W. Gould Michael Heumann Erin F. Simms Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Phone: CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Office of Surveillance, Epidemiology, and Laboratory Services Public Health Surveillance and Informatics Program Office