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PSYSTART®RESPONDERANDVICTIMTRIAGEINCIDENTMANAGEMENTSYSTEMS 1

©Copyright2001-2018,mschreiber,allrightsreserved.Unauthorizeduseorredistributionisprohibited.Allrightsreserved.

PsySTART®EmergencyMentalHealthTriageSystemsforDisastersandPublicHealthEmergenciesOverview:PsySTARTisanevidence-based,rapidmentalhealthtriagesystemthatiscompletedduringadisasterbymentalhealth,healthand/orothernon-mentalhealthworkersanddisasterresponderstodeterminetheseverityofdisasterexposureandurgencyofmentalhealthneedsofindividualswhohavearrivedatahospital,healthfacilityorothersettingfollowingadisaster.PsySTARTprovidesanonsitetooltomanageasurgeofpsychologicalcausalitiesinahealthcareorotherdisastersettingandtodetermineprioritiesbasedonurgentandlessurgentmentalhealthneeds.Itallowsforthetargeteddeploymentofmentalhealthresponderswhocanbedirectedtoindividualsmostinneedofmentalhealthsupportfirst.Inadditionfacilitatingbettersitemanagementofthedisastermentalhealthresponse,PsySTARTgeneratessummarydatashowingmentalhealthriskfactorsbyindividual,bysiteorovermultiplesitesinanimpactedjurisdiction.Thedatageneratedcanbeusedtoinformobjectives,strategies,andincidentactionplanningatahealthfacilityIncidentCommandPostorjurisdictionalEmergencyOperationsCenter(EOC)andtoprovideinformationtoassistwithmentalhealthcoordinationwithresponsepartners.UsersofPsySTARTinclude:USPublicHealthService/ASPRLosAngelesCountyEMSAgencySeattleandKingCountyStatesofMinnesota,Indiana,Tennessee,Oregon,DistrictofColumbia,NorthCentralTexasTraumaRegionalAdvisoryCouncilPsySTARTispartoftheFEMAPediatricDisasterTrainingCourseFEMA/StateofCaliforniaNorthernandSouthernCaliforniaCatastrophicEarthquakePlanningScenariosFEMA/HHSRegionVNewMadridSeismicPlanningModelPsySTARTwasapartofHHSandCDCfielddisasterresponseforthefollowingdisasters:SuperstormSandySandyHookshootingBostonMarathonbombingRoseburg,OregonSchoolShootingAmericanSamoaTsunamiAlabamaTornadoNapaValleyEarthquakeOtherPsySTARTProjects:Currently,effortsareunderwaytoleveragePsySTARTfornon-disasterbased“traumainformedcare”andpreventioninitiativesaimedatmitigationof

2 PSYSTARTTRIAGERESPONDERANDVICTIMTRIAGEANDINCIDENTMANAGEMENTSYSTEMS

©Copyright2001-2015,mschreiber,allrightsreserved

ACEs(AdverseChildhoodExperiences).ThisuseofPsySTARTwillallowcommunitiestohaveanevidence-based“traumamap”totrackanddevelopprogramstoaddresscurrentandon-goingtraumaticstressorsincommunities.

1. PsySTARTDisasterMentalHealthTriageandIncidentManagementSystem

• PsySTARTVictim/SurvivorTriageSystemforusebyEMS,hospitalEmergencyDepartments,healthclinics,andotherhealthfacilitiesaspartofthefederalHospitalPreparedness(HPP)grantprogram.

Ø HighlightsofthePsySTARTVictimSystemprojectsinclude:

• “TraintheTrainer”forthePsySTARTVictimSystemwasdevelopedanddelivered.

• JobactionsheetsforuseintheHospitalIncidentCommandSystem,• DevelopmentofaPsySTART“badgebuddy”forclinicians,• DevelopmentofaPsySTARTinformedIncidentActionPlan(IAP)

templateandtraining• ExerciseuseofPsySTARTinthestatewidedisastermedicalexercise

programwith1800triageencounterscompletedin90minutesby44participatinghospitals.

• Realworlduse(seebelow)PsySTARTVictim/Survivorsystemprovides:

• Realtimesituationalawarenessofmentalhealthriskusingarapidtriagetoolcompletedinafewsecondsbyhealth,mentalhealth,andnon-mentalhealthworkers

• Augmentsdistress-basedsymptomscreeningtoaddressevidence-basedriskfactorstotargetlimitedfollowupefficiently

§ ThecombinationofPsySTARTplusassessingfordistress-basedsymptomsprovidesanoptimalapproachtoidentifyingpeopleinimpactedcommunitieswhowouldbenefitfromfurtherdisastermentalhealthfollowupinterventions.

• PsySTARTaugments“mentalhealthsymptomscreening”duringthecritical1-45daysfollowingadisaster.

• Facilitatestargetedinterventionsbasedlevelofimpact.Forexample,usingPsychologicalFirstAid(PFA)bynon-MHproviderscanaddresstheeducationandresiliencysupportneedsofthosepeoplewhoareleastimpactedandareexperiencingtypical,expected,andnormativereactionstothedisaster.



• Facilitatestargetedinterventionsforhigherriskindividualswhomayrequire

moreintensiveinterventionssuchassecondaryassessment,crisisintervention,orreferralsfortrauma-informedmentalhealthcare.

• Canbecompletedquicklyandaccuratelyindisasterlocationsbynon-mentalhealthtrainedproviders.

• Mostriskfactorsdonotrequirea“directinterview”ofdisastersurvivors.Forexample,PsySTARTtriageriskfactorscanbecapturedfromotherinformationalreadycollectedincluding:

o EDpatienthistoryo Shelter,FamilyAssistanceCenters,orPublicHealth

PODregistrationformso CommunityInformationfromOutreachteamso Caseworkinformationfrompartnerorganizationssuch

astheAmericanRedCross.o Forchildren,theparentorcaregivercanprovidethe

PsySTARTinformationwithoutaskingthechild.o Oncesensitiveinformationsuchasdeathorinjuryof

familymembers,homeloss,orpetlosshasbeenreported,theindividualdoesnothavetobeaskedaboutthosedisaster–relatedlossesagain.

• Providesgeo-coded,map-basedinformationthatPsySTARTsystemadministratorscanusetoassessthementalhealthriskimpactbydisasterresponse/servicelocations(i.e.hospital,shelter,clinic,mobileoutreachteam,etc.),countyOperationalArea,byregion,orstatewidedependingontheinformationalneedsofadisaster.

• PsySTARTdataprovides“incidentdecisionsupport”todevelopEOCandCommandPostIncidentActionPlans(IAPs).

• Firstknowndata(surveillance)drivendisastermentalhealthtoolthatcanbeusedtoobtainreal-time“situationalawareness”,gapanalysis,andmentalhealthimpactdatatosupportmutualaidrequests,federalStaffordActassistance,andVictimsofcrimefundingrequests.

• Conformsto“crisisstandardsofcare”byinformingallocationofscarcementalhealthresourcestothoseatgreatestriskbyethical,evidence-basedriskprotocol.

o Includes“floatingtriagealgorithms”whichtargetsandmatchespopulationriskacuitytoavailablementalhealthstaffingresourcesinajurisdiction.



• ProvidesacommonoperatingpictureofpopulationrisklevelsduringPublicHealthemergenciestoassessthementalhealthimpactfor:

o Peoplewhoareillandhavebeenisolatedinahospitalo Peoplewhoareunderquarantineincludingfamilymembers,co-

workers.o Peoplewhoareworriedaboutexposure,includingneighbors,co-

workers,otherfamilymemberso PeopleexperiencingthelossoflovedonesduetoaPublicHealth

emergency

• CanbeusedtoprovidepopulationmentalhealthimpactdatatosupportrequestsforFederalStaffordActCrisisCounselingProgram(CCPgrant)applicationsandprogramstrategiesbyprovidingdataonpopulationsatrisk,sourcesofrisk,andlocationsofpopulationswithhighmentalhealthimpactandriskinimpactedcommunities.

• Providesseparateimpactinformationforchildrenthatareseparatefromadultimpactdata.

• Providesadecisionsupporttoolformentalhealthworkerswhoarerespondingtodisastersitesthatallowsforthematchingofpeoplewithcertainriskfactorswiththerighttypeofresponderneeded.

o Forexample,thosetriagedasexperiencinglossoflovedoneorpetscouldbematchedwithchaplaincysupportortrainedgriefcounselors.

• Providesactionabledataon“worriedwell”trendsinimpactedcommunitieswhichcaninformtargetedriskcommunicationorothercrisismanagementstrategiesspecifictopopulationswithconcernsaboutexposuretodiseaseorcontaminationinhealthcareorotherdisastersettings.

• Enablesa“continuumofcare”approachtoprovidethoseatriskwithearlyinterventiontofacilitateresilience.

(SeeexampleofthePsySTARTMentalHealthTriagetoolbelow.)



REPSONDERRISKANDRESILIENCE-PsySTARTResponderSelfTriageSystemPublicHealthEmergenciesOverview:PsySTARTalsoincludesPsySTARTResponderSelf-TriageSystemandaonehour“Anticipate,PlanandDeter”staffresiliencytrainingandpersonalresilienceplan.“Anticipate,PlanandDeter”isapre-event“stressinoculation/personalresilienceplan”trainingthatcanbegiventoemergencyhealthworkerslikelytobetaskedwithrespondingtodisastersorotherpublichealthemergencies.The“PsySTARTSelf-TriageResponderSystem”isatoolthatusesexposurestocertainevents,notpsychologicalsymptoms,tomonitorpotentialmentalhealthriskstohealthcarerespondersduringadisasterresponse.Becauseofitsuniquefeatures,thePsySTARTResponderSystemprovidesanon-stigmatizingtoolthatmeasuresobservablerisks.Italsoprovidesthosewhoareinchargeofemployeehealthwith“actionabledata”thatsupportstheuseofmentalhealthresiliencystrategiesforrespondersthroughouttheirdisasterassignment.ThePsySTARTResponderSystemandAnticipatePlanDetertrainingcanalsobeusedforemerginginfectiousdiseasethreatsandotherpublichealthemergenciestoaddressresponderresiliencyandriskexposure.ElementsdevelopedatEMSaspartoftheHospitalPreparednessProgram(HPP)grantinclude:

• PsySTARTResponderSelfTriageSystemforusebyEMS,hospitalEmergencyDepartments,healthclinics,andotherhealthfacilitiesaspartofthefederalHospitalPreparedness(HPP)grantprogram.

• Anticipate,PlanandDetertrainingandbrochureincludingthefollowingtrainingelements:

o Anticipate:– Pre-incident“stressinoculation”trainingregarding:

• Situationshealthcareemployeesmightencounter– Crisiscaredecisions– Directfamilyimpacts– Stigma

• Impactofstressonresponderso Plan:

– Howtobuildapersonal“resilienceplan”– Howtoharnessstrengthsemployeesusenowinadisaster– Howhealthcareemployeescanenhancesocialsupport– Howemployeescanusebasic“Neighbortoneighbor”

PsychologicalFirstAid(LPCN2N)inadisastero Deter:

– Howtoactivateindividual/teamresilienceplansduringadisaster



– Howemployeescantrackexposuretotraumaticandcumulativestressfactors

– Howtogetmorementalhealthsupportifneeded

• PsySTARTRespondersystemgeneratesaggregated,de-identified,population-levelresponderriskdatathatPsySTARTsystemadministrators(suchasincludingEmployeeHealthandWell-BeingUnitLeadersassignedtooverseeemployeehealthandmentalhealth)canusetomaintainreal-timesituationalawarenessofthementalhealthimpactofadisasterresponseforemployees.Otherimprovementswillinclude:

o The“app”versionwillalsoprovideanevidence-based,non-

stigmatizingtoolthatbuildsonthe“Anticipate,PlanandDeterresponderresiliencetrainingbygivingrespondersinformationontheirownacuteorcumulativeriskexperiencedduringtheirdisasterassignment.

o The“app”versionofPsySTARTResponderwillalsoprovidetheindividualresponderusingtheappwiththeabilitytoviewtheirownconfidential,cumulativerisktrendingforeachdayoftheirdisasterdeployment.Responderscanelecttosharethisimpactinformationwiththeirsupervisor,staffmentalhealthprovider,orpeersupport“buddy”attheirdiscretion.

o The“app”versionwillalsogenerate“de-identified”real-time“situationalawareness”dataonthementalhealthimpactonrespondersworkingonaparticulardisasterthatare“geocoded”bydisasterresponsesite,team,anddisciplineforusebythosechargedwithrespondersafetyandhealth.

o ThePsySTARTResponderSelf-TriageSystemdoesnotrelyexclusivelyonmeasuringresponder“symptoms”ornormal/expected“transitorydistress”.Italsodoesnotrequirethatrespondersprovidea“recitaloffeelingsorworstmoments”oftheirdisasterresponseexperience.

o The“app”versionwillalsoprovide“riskexposuredata/information”

torespondersandtothoseoverseeingresponderdisastermentalhealth,sothatthe“continuumofriskexposure”thatrespondersareexperiencingcanbeproactivelydetermined.

o ThePsySTARTResponderSelf-TriageSystemsupports“mission

assurance”byhelpingthoseinchargeofrespondermentalhealthwithinformationthatsupportsearlyinterventionstrategiestoaddressresponderrisksspecifictohazardsrespondersareexperiencingratherthanwaitinguntiltheendoftheresponder’s



disasterassignmenttoassesstheemotionalimpactoftheirdisasterassignment.

• RealworlduseofthePsySTARTResponderSystemandAnticipatePlanand

Detertrainingincludes:o TheUSPublicHealthresponsetotheEbolaoutbreakinAfrica.Here

thesystemwasusedbydeployedmedicalteamsforover100days(Oct20,2014toApril2015).Itprovidedsituationalawarenessofrisktrending,numbersofindividualsrequiringmorein-depthmentalhealthassessmentorsupportandprovidedforreal-timeintervention/mitigationofresponderstresshazards.

o PsySTARTresponderwasalsousedinSuperTyphoonHaiyanbyEMSprovidersandprovidedevidencethatverifiedtheuseofPsySTARTRespondertopredictindividualandteamlevel-riskmetricsforpost-deploymentresponderoutcomes.

(SeeexampleofthePsySTARTResponderSelfTriageSystemtoolbelow.)

Formoreinformationpleasecontact:

Merritt D. Schreiber, Ph.D. Professor of Clinical Pediatrics Department of Pediatrics Harbor-UCLA Medical Center David Geffen School of Medicine at UCLA

949-424-9178

24hr access: 202-630-5577

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