Staff Perspective: Building Your Emergency Support Toolkit
The following blog will reference a website developed by the Center for Deployment Psychology in conjunction with support from members of Division 19 of the American Psychological Association. The website, “Resources for Providers in Times of War,” can be found here: https://deploymentpsych.org/resources-for-providers-in-wartime
Take a moment and think about the ways you prepare for emergency situations in your personal life. Various activities might come to mind, like stocking up on essentials at the grocery store when a major storm is about to blow through your community. Perhaps you imagine gathering phone numbers and contact information for loved ones and providers that serve you or your family members, imagining a scenario in which hard news needs to be communicated or individuals found for support. In case of fire, you might have a plan for how to leave a bedroom to arrive safely outside of your residence. Whatever the emergency that came to mind, it is likely that you thought of your readiness to respond; use of information, tangible resources, or products; and/or connection with others.
The geopolitical events unfolding in Ukraine have offered a glance into the effort required for behavioral health providers to suddenly shift their efforts and focus from their typical practice to whole population support in the face of continual adversity. I had the opportunity to participate in The Center for Deployment Psychology’s coordinated effort to gather resources, information, and expertise in support of the American Psychological Association’s Division 19’s response to requests from the National Psychological Association of Ukraine (NPAU) for identifying how to help behavioral health providers respond to acute, ongoing crisis. It was a moment of responding to a true emergency situation and it made me reflect on our actual readiness for response to continual crisis and the nature of available resources.
While most of us do not find ourselves in a current situation mirroring the events unfolding in Ukraine, we can easily discover ourselves in an emergency situation in which we need to suddenly respond to unexpected needs that supercede our usual bounds of practice (and even competence). As you read this blog, I invite you, the reader, to consider your readiness to respond in a situation of acute adversity striking either individuals or groups. Where you identify gaps, I hope you will refer to the website “Resources for Providers in Times of War” and consider the repository of materials available for your use. Just as you may have an emergency preparedness toolkit for your personal life, consider the merits of using this website as a toolkit and/or developing your own professional emergency preparedness toolkit for behavioral health encounters occurring at the point of acute adversity and ongoing distress.
Readiness to Respond.
Ability to respond is often variably successful as a function of readiness to respond. Recent years have reminded us that emergency or crisis situations can happen en masse without much advance notice. While many behavioral health providers are practiced in developing safety or response plans for individuals experiencing an individual crisis, historically, fewer are functioning in a manner in which they respond to emergencies that happen to a larger population. The onset of the COVID-19 pandemic was a recent thrust into a situation in which whole societies needed to adapt ways of life at a moment’s notice, and virtually every front line worker became a point of possible intervention for psychological distress (Choong, Chai, Huri, Nawawi, & Ibrahim, 2020) - the pandemic found us, ready or not. We demonstrated that adaptation to telehealth is possible (ATA, 2020a) and can lead to even some positive outcomes in patient satisfaction and access to care (ATA, 2020b), but the degree of effort required to pivot successfully likely varied as a function of readiness for certain situations. For example, providers already utilizing telehealth and/or in organizations with existing supportive postures towards telehealth arguably had an easier transition to increasing the scope of online service provision versus those who had been reluctant to the experience previously (Pierce, Perrin, & McDonald, 2020; Pierce, Perrin, Tyler, McKee, & Watson, 2021).
The response to the onset of the pandemic was challenging, but taking days or weeks to develop capacity for telehealth was sufficient in most circumstances to accommodate the needs of clients or patients. Unfortunately, situations like the conflict in Ukraine are a reminder that sometimes the need to respond is immediate, urgent, and of substantial consequence. Further, although there is great attention, time, and investment to developing trainings for psychological distress, these initiatives continue to target mostly frontline emergency responders without consideration of the larger population of behavioral health providers (such as is the case with dissemination of Psychological First Aid; Wang, Norman, Xiao, Li, & Leamy, 2021). Simply stated, as seemed to be the case for Ukrainian psychologists, most of us engaged in behavioral health duties in the United States have little to no formal preparation for continual engagement in situations of ongoing acute stress. While CDP was able to facilitate (via APA) connection with some resources within 24 hours, it is unknown how much longer it may have taken to disseminate needed support to providers in-country given issues with communication methods as well as provider readiness to acquire new knowledge without any existing training in disaster response. It was a stark reminder that it is harder to respond immediately when at the moment of crisis one is starting at the beginning of seeking what is available.
Information, Resources, and Products.
As professionals and organizations across the country shared resources with APA and CDP, it became clear that there are rich documents and manuals describing intervention protocols or management of psychological distress after a traumatic event (think about Psychological First Aid, for example). These developed approaches were difficult to digest and implement, however, when the helpers themselves were experiencing acute distress and had limited bandwidth to suddenly learn a whole approach. In addition, amongst resources there were relatively few targeting the intensity of recurring stressors when the traumatizing stimulus is ongoing and has not ended. Taken in combination with the lack of time to fully train up on protocols or manuals, it became clear that there was a need for easily digestible snippets of information that give direct guidance for how to engage in the moment of acute stress as well as in the face of predicted ongoing stress.
Some highly useful and engaging content was developed in honor of this need for brief, targeted information at the point of crisis. I encourage readers to visit the “Resources for Providers in Times of War” to explore these resources further (paying particular attention to the section “Resources for Crisis and Situations Involving Acute Stress”). There are short videos and pocket cards that give explicit guidance on how to support sleep, assess for Traumatic Brain Injury, and manage combat stress reactions during a period of continual conflict. In addition, there is a package of materials introducing how to use Stress First Aid, a psychosocial support approach when there is ongoing adversity (and thus complementary to Psychological First Aid), and available in easy-to-view short videos to allow for providers to quickly acquire and then apply the approach. Unique to all of these resources is a sense of helping an individual get a foothold to return to a sufficient level of functioning to continue managing high levels of stress, acknowledging fuller recovery will not be possible until later down the road.
Connection to Others.
Perhaps most critically, this experience was a reminder that there is little substitute for the support of others. In the face of crisis, one of NPAU’s first steps was to reach out and to ask for help. Just as important was the related and prolific offering of support that came in response to the call from Division 19 of APA. Help came in the form of both materials (handouts, manuals, and apps from entire organizations and individual contributors) and time (organizations developing websites, a team at CDP who developed resources to meet a critical need, and a collection of APA Division 19 members who reviewed offered resources to identify the most critical pieces of information to send in early waves of the response effort). Of interest, no one group had all the needed materials - it truly required a whole community of organizations and providers to be effective in a response. To me, recent years seem to be emphasizing repeatedly that we are meant to live in community; that we are stronger together; and, just as would be suggested by ethical codes and best practices, we should seek consultation and collegial support to enhance our competence.
In conclusion.
Emergencies come in many forms, but will eventually land upon the door of most behavioral health providers. While always meritable to train ahead of time for how to respond in a crisis, becoming aware of where to seek resources and how to apply them is an important second best. Further, building your professional network can embolden your practice now and safeguard your ability to develop a response when a crisis occurs. I hope this blog has increased your awareness of some available resources and your readiness to make use of them, should the need arise.
Please visit CDP’s Resources for Providers in Times of War, an evolving catalog of resources and links that may serve as a starting point for developing an emergency preparedness toolkit.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Andrea Israel, Ph.D., is a clinical psychologist serving as a Military Behavioral Health Child Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References
American Telemedicine Association (2021a). The adoption of telehealth. Arlington, VA: The
American Telemedicine Association.
American Telemedicine Association (2021b). Patient satisfaction with virtual care. Arlington, VA:
The American Telemedicine Association.
Choong, T. C., Chai Y. C., Huri S. Z., Nawawi W. Z. W., & Ibrahim, N.(2020). Innovative
psychological first aid (PFA) in the new normal for frontliners. Perspectives in Psychiatric
Care, 57(2), 965-967.
Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2020). Path analytic modeling of psychologists’
openness to performing clinical work with telepsychology: A national study. Journal of
Clinical Psychology, 76, 1135-1150.
Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021). The COVID-19
telepsychology revolution: A national study of pandemic-based changes in U.S. mental
health care delivery. American Psychologist, 76(1), 14-25.
The following blog will reference a website developed by the Center for Deployment Psychology in conjunction with support from members of Division 19 of the American Psychological Association. The website, “Resources for Providers in Times of War,” can be found here: https://deploymentpsych.org/resources-for-providers-in-wartime
Take a moment and think about the ways you prepare for emergency situations in your personal life. Various activities might come to mind, like stocking up on essentials at the grocery store when a major storm is about to blow through your community. Perhaps you imagine gathering phone numbers and contact information for loved ones and providers that serve you or your family members, imagining a scenario in which hard news needs to be communicated or individuals found for support. In case of fire, you might have a plan for how to leave a bedroom to arrive safely outside of your residence. Whatever the emergency that came to mind, it is likely that you thought of your readiness to respond; use of information, tangible resources, or products; and/or connection with others.
The geopolitical events unfolding in Ukraine have offered a glance into the effort required for behavioral health providers to suddenly shift their efforts and focus from their typical practice to whole population support in the face of continual adversity. I had the opportunity to participate in The Center for Deployment Psychology’s coordinated effort to gather resources, information, and expertise in support of the American Psychological Association’s Division 19’s response to requests from the National Psychological Association of Ukraine (NPAU) for identifying how to help behavioral health providers respond to acute, ongoing crisis. It was a moment of responding to a true emergency situation and it made me reflect on our actual readiness for response to continual crisis and the nature of available resources.
While most of us do not find ourselves in a current situation mirroring the events unfolding in Ukraine, we can easily discover ourselves in an emergency situation in which we need to suddenly respond to unexpected needs that supercede our usual bounds of practice (and even competence). As you read this blog, I invite you, the reader, to consider your readiness to respond in a situation of acute adversity striking either individuals or groups. Where you identify gaps, I hope you will refer to the website “Resources for Providers in Times of War” and consider the repository of materials available for your use. Just as you may have an emergency preparedness toolkit for your personal life, consider the merits of using this website as a toolkit and/or developing your own professional emergency preparedness toolkit for behavioral health encounters occurring at the point of acute adversity and ongoing distress.
Readiness to Respond.
Ability to respond is often variably successful as a function of readiness to respond. Recent years have reminded us that emergency or crisis situations can happen en masse without much advance notice. While many behavioral health providers are practiced in developing safety or response plans for individuals experiencing an individual crisis, historically, fewer are functioning in a manner in which they respond to emergencies that happen to a larger population. The onset of the COVID-19 pandemic was a recent thrust into a situation in which whole societies needed to adapt ways of life at a moment’s notice, and virtually every front line worker became a point of possible intervention for psychological distress (Choong, Chai, Huri, Nawawi, & Ibrahim, 2020) - the pandemic found us, ready or not. We demonstrated that adaptation to telehealth is possible (ATA, 2020a) and can lead to even some positive outcomes in patient satisfaction and access to care (ATA, 2020b), but the degree of effort required to pivot successfully likely varied as a function of readiness for certain situations. For example, providers already utilizing telehealth and/or in organizations with existing supportive postures towards telehealth arguably had an easier transition to increasing the scope of online service provision versus those who had been reluctant to the experience previously (Pierce, Perrin, & McDonald, 2020; Pierce, Perrin, Tyler, McKee, & Watson, 2021).
The response to the onset of the pandemic was challenging, but taking days or weeks to develop capacity for telehealth was sufficient in most circumstances to accommodate the needs of clients or patients. Unfortunately, situations like the conflict in Ukraine are a reminder that sometimes the need to respond is immediate, urgent, and of substantial consequence. Further, although there is great attention, time, and investment to developing trainings for psychological distress, these initiatives continue to target mostly frontline emergency responders without consideration of the larger population of behavioral health providers (such as is the case with dissemination of Psychological First Aid; Wang, Norman, Xiao, Li, & Leamy, 2021). Simply stated, as seemed to be the case for Ukrainian psychologists, most of us engaged in behavioral health duties in the United States have little to no formal preparation for continual engagement in situations of ongoing acute stress. While CDP was able to facilitate (via APA) connection with some resources within 24 hours, it is unknown how much longer it may have taken to disseminate needed support to providers in-country given issues with communication methods as well as provider readiness to acquire new knowledge without any existing training in disaster response. It was a stark reminder that it is harder to respond immediately when at the moment of crisis one is starting at the beginning of seeking what is available.
Information, Resources, and Products.
As professionals and organizations across the country shared resources with APA and CDP, it became clear that there are rich documents and manuals describing intervention protocols or management of psychological distress after a traumatic event (think about Psychological First Aid, for example). These developed approaches were difficult to digest and implement, however, when the helpers themselves were experiencing acute distress and had limited bandwidth to suddenly learn a whole approach. In addition, amongst resources there were relatively few targeting the intensity of recurring stressors when the traumatizing stimulus is ongoing and has not ended. Taken in combination with the lack of time to fully train up on protocols or manuals, it became clear that there was a need for easily digestible snippets of information that give direct guidance for how to engage in the moment of acute stress as well as in the face of predicted ongoing stress.
Some highly useful and engaging content was developed in honor of this need for brief, targeted information at the point of crisis. I encourage readers to visit the “Resources for Providers in Times of War” to explore these resources further (paying particular attention to the section “Resources for Crisis and Situations Involving Acute Stress”). There are short videos and pocket cards that give explicit guidance on how to support sleep, assess for Traumatic Brain Injury, and manage combat stress reactions during a period of continual conflict. In addition, there is a package of materials introducing how to use Stress First Aid, a psychosocial support approach when there is ongoing adversity (and thus complementary to Psychological First Aid), and available in easy-to-view short videos to allow for providers to quickly acquire and then apply the approach. Unique to all of these resources is a sense of helping an individual get a foothold to return to a sufficient level of functioning to continue managing high levels of stress, acknowledging fuller recovery will not be possible until later down the road.
Connection to Others.
Perhaps most critically, this experience was a reminder that there is little substitute for the support of others. In the face of crisis, one of NPAU’s first steps was to reach out and to ask for help. Just as important was the related and prolific offering of support that came in response to the call from Division 19 of APA. Help came in the form of both materials (handouts, manuals, and apps from entire organizations and individual contributors) and time (organizations developing websites, a team at CDP who developed resources to meet a critical need, and a collection of APA Division 19 members who reviewed offered resources to identify the most critical pieces of information to send in early waves of the response effort). Of interest, no one group had all the needed materials - it truly required a whole community of organizations and providers to be effective in a response. To me, recent years seem to be emphasizing repeatedly that we are meant to live in community; that we are stronger together; and, just as would be suggested by ethical codes and best practices, we should seek consultation and collegial support to enhance our competence.
In conclusion.
Emergencies come in many forms, but will eventually land upon the door of most behavioral health providers. While always meritable to train ahead of time for how to respond in a crisis, becoming aware of where to seek resources and how to apply them is an important second best. Further, building your professional network can embolden your practice now and safeguard your ability to develop a response when a crisis occurs. I hope this blog has increased your awareness of some available resources and your readiness to make use of them, should the need arise.
Please visit CDP’s Resources for Providers in Times of War, an evolving catalog of resources and links that may serve as a starting point for developing an emergency preparedness toolkit.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Andrea Israel, Ph.D., is a clinical psychologist serving as a Military Behavioral Health Child Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
References
American Telemedicine Association (2021a). The adoption of telehealth. Arlington, VA: The
American Telemedicine Association.
American Telemedicine Association (2021b). Patient satisfaction with virtual care. Arlington, VA:
The American Telemedicine Association.
Choong, T. C., Chai Y. C., Huri S. Z., Nawawi W. Z. W., & Ibrahim, N.(2020). Innovative
psychological first aid (PFA) in the new normal for frontliners. Perspectives in Psychiatric
Care, 57(2), 965-967.
Pierce, B. S., Perrin, P. B., & McDonald, S. D. (2020). Path analytic modeling of psychologists’
openness to performing clinical work with telepsychology: A national study. Journal of
Clinical Psychology, 76, 1135-1150.
Pierce, B. S., Perrin, P. B., Tyler, C. M., McKee, G. B., & Watson, J. D. (2021). The COVID-19
telepsychology revolution: A national study of pandemic-based changes in U.S. mental
health care delivery. American Psychologist, 76(1), 14-25.