Fluent Essays

For your Final Paper, you will apply concepts, principles, and theories presented in the course as they relate to a specific type of disaster, crisis, or trauma of your choice. Your paper should be 10–12 pages (not including references, title page, or abstract), double-spaced, with proper APA formatting. Your paper must include all of the following elements: • A minimum of 10 references (in addition to any course readings that you may wish to reference) • A description of the type of disaster, crisis, or trauma you selected • An explanation of the crisis intervention approach you would use to respond to the disaster, crisis, or trauma • An analysis of ethical, legal, and multicultural considerations related to the disaster, crisis, or trauma • An assessment of the potential impact of the disaster, crisis, or trauma including the following areas: o Affect o Behavior o Cognition o Development o Ecosystems • An explanation of the global impact of the disaster, crisis or trauma • A description of the crisis intervention strategies and skills (including Psychological First Aid) you would use and an explanation of how you would use each • An explanation of the potential long-term psychological effects (e.g., transcrisis state, PTSD) of the disaster, crisis, or trauma • A description of potential risk and resilience factors and an explanation of how each might impact recovery • An analysis of trends and/or future research related to the disaster, crisis, or trauma Although the Final Paper is not to be submitted until Day 7 of Week 10, you should become familiar with the paper requirements and have them in mind as you proceed through the course. Be sure to protect the identity of any real persons used in your paper. No identifying information should be used. The Final Paper will be evaluated according to the Final Project Rubric. The Final Paper is worth 39\% of your final grade. © 2014 Laureate Education, Inc. This should reflect scholarly writing. disaster_related_physical_and_mental_health_.pdf lessons_learned_about_psychosocial_responses_to_disaster_and_mass_trauma_an_international_perspective.pdf ethical_issues_in_trauma_related_reserch.pdf ptsd_dsm_5.pdf assessment_a_developmenta_eco_perspective.pdf Unformatted Attachment Preview Disaster-Related Physical and Mental Health: A Role for the Family Physician JOHN R. FREEDY, M.D., Ph.D., and WILLIAM M. SIMPSON, JR., M.D. Medical University of South Carolina, Charleston, South Carolina Natural disasters, technologic disasters, and mass violence impact millions of persons each year. The use of primary health care services typically increases for 12 or more months following major disasters. A conceptual framework for assisting disaster victims involves understanding the individual and environmental risk factors that influence post-disaster physical and mental health. Victims of disaster will typically present to family physicians with acute physical health problems such as gastroenteritis or viral syndromes. Chronic problems often require medications and ongoing primary care. Some victims may be at risk of acute or chronic mental health problems such as post-traumatic stress disorder, depression, or alcohol abuse. Risk factors for post-disaster mental health problems include previous mental health problems and high levels of exposure to disaster-related stresses (e.g., fear of death or serious injury, exposure to serious injury or death, separation from family, prolonged displacement). An action plan should involve adequate preparation for a disaster. Family physicians should educate themselves about disaster-related physical and mental health threats; cooperate with local and national organizations; and make sure clinics and offices are adequately supplied with medications and suture and casting material as appropriate. Physicians also should plan for the care and safety of their own families. (Am Fam Physician 2007;75:841-6. Copyright © 2007 American Academy of Family Physicians.) For a recent commentary on this topic, please see Swain GR, Burns K. Emergency response: physician training and obligations. Am Fam Physician 2007;75:401-5 (http://www.aafp.org/ afp/20070201/curbside. html). T he American Red Cross defines a disaster as involving 100 or more persons, 10 or more deaths, or an appeal for assistance.1 Qualifying events include natural disasters (e.g., hurricanes, earthquakes, floods, tornadoes), technologic disasters (e.g., nuclear or industrial accidents), and mass violence (e.g., terrorist attacks, shooting sprees). The annual worldwide impact of disasters is substantial, with an average of more than 500 incidents impacting 80 million persons, displacing 5 million from their homes, seriously injuring 74,000, and killing 50,000.2 Although most largescale disasters occur in developing countries, events such as Hurricane Katrina in 2005 and the September 11 terrorist attacks in 2001 are reminders that the United States is not immune to large-scale disasters.3 Years of research and applied practice have produced a consensus about the vulnerability of the U.S. population to disasters. Accepted facts include: (1) disasters are common events that affect millions of persons annually; (2) with more persons living in disaster-prone areas and increased technologic complexity, it is expected that the risk and impact of disasters will increase in future years; and (3) disasters are associated with a variety of adverse physical and mental health effects that can range from mild and transient to severe and chronic.4 Family physicians are well suited to address the physical and mental health needs of disaster victims. Disaster exposure increases primary health care use for 12 months or more after the event.5 More importantly, the acute and chronic physical and mental health issues that most commonly occur after a disaster are within the scope of practice for family physicians and other board-certified primary care physicians.3,4,6-8 Risk Factor Model Table 1 presents a risk factor model for postdisaster adjustment.4 Research supporting Downloaded from the American Family Physician Web site at www.aafp.org/afp. Copyright ©2007 American Academy of Family Physicians. For the private, noncommercial ◆ Volume of one individual75, userNumber of the Web Contact copyrights@aafp.org for copyright questions and/or permission requests. March 15, use 2007 6 site. All other rights reserved. www.aafp.org/afp  American Family Physician 841 Disaster-Related Health SORT: KEY RECOMMENDATIONS FOR PRACTICE Clinical recommendation Disaster victims with high levels of disaster exposure should be monitored for the possible emergence of post-traumatic stress disorder, depression, or alcohol abuse. Mental health screening measures should be used to efficiently and accurately identify adults who may be experiencing mental health problems following a disaster. Evidence rating References C 4, 13, 15 disaster result in an inability to cope effectively after the disaster. In general, ethnic minority status and lower income have been associated with C 27-32 poorer post-disaster physical and mental well-being.9 Although being married appears to help men, a married woman may experience poorer post-disaster adjustment if her A = consistent, good-quality patient-oriented evidence; B = inconsistent or limitedmarital status results in her giving out more quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual social support than she receives.4-7 practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 789 or http://www.aafp.org/afpsort.xml. Pre-disaster life events also may have an impact on post-disaster physical and mental health. Exposure to traumatic events has this model is briefly summarized to orient family physi- been associated with a range of mental health problems cians to these risk factors. When clinically evaluating (e.g., post-traumatic stress disorder [PTSD]) that can persons after a disaster, family physicians should con- impact post-disaster response.10 Less intensely stresssider these individual and environmental risk factors to ful life events (e.g., financial or marital problems) assess potential impact on patients’ physical and mental existing one year before disaster exposure have been health. associated with increased physical and psychological A person’s response to a disaster is determined by symptom reports.9,10 demographic and socioeconomic factors, as well as the In terms of mental health, a history of pre-disaster person’s pre-disaster mental health and the extent of symptoms can predict the presence of post-disaster his or her social support before, during, and after the symptoms. Also, persons with pre-disaster mental health event. Regarding demographic factors, children typically histories are more likely to display post-disaster mental display emotional distress when family conflict occurs; health problems including PTSD.8 middle-age adults experience psychological and physical Predictors of effective coping can help triage lessproblems when a disaster makes it impossible to meet needy patients. Coping refers to cognitive and behavresponsibilities4,6-8 ; and older adults most often display ioral abilities to solve problems, manage emotions, or post-disaster physical and mental health problems when disengage from difficult problems or emotions.11 In limits on income, health, or social support before the general, successful coping is characterized by flexibility, creative thinking, willingness to try new things, action orientation, working cooperaTable 1 tively with others, and the ability to tolerate Risk Factor Model for Post-Disaster Adjustment* frustration or other strong emotions.6,7,12 The impact of pre-disaster social supThe rights holder did not grant the American Academy of Family port on post-disaster well-being is complex. Physicians the right to sublicense this material to a third party. For the Generally, victims’ post-disaster adjustment missing item, see the original print version of this publication. can be improved if they perceive that they are supported, if they receive more support than they give, or if they are embedded in a healthy social network.6,7 Within a disaster, exposure has objective (e.g., serious injury, death) and perceived (e.g., sensing threat to life) elements. High levels of disaster exposure increase the risk of developing PTSD or other severe mental health problems following the disasAdapted with permission from Freedy JR, Resnick HS, Kilpatrick DG. Conceptual frameter.4 Family physicians must be comfortable work for evaluating disaster impact: implication for clinical intervention. In: Austin LS. in tactfully, directly, and privately asking Responding to Disaster: A Guide for Mental Health Professionals. 1st ed. Washington, D.C.: American Psychiatric Press, 1992:6. patients about exposure to within-disaster mental health risk factors. 842 American Family Physician www.aafp.org/afp Volume 75, Number 6 ◆ March 15, 2007 Disaster-Related Health Common Post-Disaster Health Outcomes The probability of a particular post-disaster physical or mental health condition varies according to the time since the disaster onset. It is helpful to divide the post-disaster time frame into acute (less than one month), intermediate (one to 12 months), or long-term (i.e., chronic; longer than 12 months) phases. Another way to view the post-disaster time frame is in terms of the potential to experience a series of chronic low-level stresses that may overwhelm coping resources.4,8,13-16 Family physicians can be key agents in lessening post-disaster physical and mental health reactions. Key points include providing information, remaining empathic, encouraging victims to seek and accept assistance, advocating self-determination to the extent feasible, reminding persons of how they may have successfully coped with previous troubles, and repeatedly checking on disaster victims for up to 12 months (or longer for more severely devastating events).17 Physical and mental health effects of disasters often coexist. In some instances, physical problems may increase the probability of mental health problems. For example, a disaster may exacerbate a chronic health condition such as diabetes or congestive heart failure (CHF), with worsening physical health contributing to the development or exacerbation of depression. The reverse direction of causality is possible, with mental health problems resulting in poorer health maintenance efforts and deterioration in chronic health problems. physical health outcomes Table 24-9,18-26 presents common post-disaster health problems. Physical problems fall into four categories: (1) acute injuries; (2) acute problems; (3) chronic problems; and (4) medically unexplained physical symptoms. More than one half of acute post-disaster health issues are illnesses (e.g., self-limited viral syndromes, gastroenteritis).20-24 Approximately one fourth of acute post-disaster health complaints are injuries (e.g., cuts, abrasions, sprains, fractures). Other acute post-disaster health issues include routine items such as medication refills, wound checks, and splinting.19 It is common for disaster victims to require assistance in the management of chronic health problems (e.g., diabetes, hypertension, CHF). Simple provision of medication and medical supplies may be sufficient. Depending on the degree to which the disaster has impacted community infrastructure, such assistance may be required as part of the intermediate or even long-term phase of post-disaster adjustment. March 15, 2007 ◆ Volume 75, Number 6 Somatic complaints without organic cause, sometimes described as medically unexplained physical symptoms, are common following a disaster. These unexplained symptoms also are associated with mental health problems such as depression, PTSD, and other anxiety disorders.26 Family physicians should increasingly consider a mental health explanation for vague, unexplained physical symptoms as time since the disaster increases. mental health outcomes Most patients with post-disaster mental health problems had similar problems before the disaster occurred. In such cases, the role of the family physician includes the provision of medication refills, supportive counseling, and appropriate referrals when indicated and feasible. Table 2 Common Post-Disaster Health Problems Mental health Acute responses18 Examples: Cognitive dysfunction or distortion; dysfunctional interpersonal behaviors; emotional lability; nonorganic physical symptoms Chronic problems 4,6-8 Examples: Alcohol abuse or dependence; depression; interpersonal violence; PTSD or other anxiety disorders; schizophrenia or other severe chronic disorders New-onset mental health problems6-8 Examples: Acute stress disorder possibly evolving to PTSD; alcohol abuse or dependence; depression; interpersonal violence Physical health Acute injuries19 Examples: Cuts or abrasions; fractures; motor vehicle crashes; occasional self-inflicted wounds; sprains or strains Acute problems20-24 Examples: Gastroenteritis or dehydration; head lice; pulmonary problems; rashes; rodent-borne illness; selflimited viral syndrome; toxic exposures; vector-borne illness Chronic problems5,9,20,25 Examples: Congestive heart failure; diabetes; hypertension; pulmonary problems (e.g., chronic obstructive pulmonary disease, acute bronchitis, asthma) Medically unexplained physical symptoms26 Examples: Fatigue; gastrointestinal complaints; headaches; other generally vague somatic complaints without clear organic etiology PTSD = post-traumatic stress disorder. Information from references 4 through 9, and 18 through 26. www.aafp.org/afp American Family Physician 843 Disaster-Related Health Table 3 Sample Questions to Assess Within-Disaster Risk Factor Exposure* Acute post-disaster psychological distress includes emotional lability; negative emotions; cognitive dysfunction and distortions (e.g., reduced concentration, confusion, unwanted thoughts or memories); physical symptoms (e.g., headaches, tension, fatigue, gastrointestinal upset, appetite changes); and behaviors that negatively affect interpersonal relationships (e.g., irritability, distrust, withdrawal, being overly controlling). For most persons, acute psychological distress will resolve within weeks to several months, but it can persist for up to one year. Distress tends to resolve as victims are able to reliably meet their basic needs.18 More severe new-onset mental health problems can occur, with the presentation ranging from obvious to subtle. The most common post-disaster mental health problems appear to be depression, PTSD, and other anxiety disorders.8 Increases in alcohol or drug abuse and domestic or interpersonal violence also have been noted.6,7 Family physicians should consider screening for common mental health problems among vulnerable populations, such as persons with a history of mental health issues, perceived life threat, serious injury, or exposure to death. A two-stage mental health screening process is recommended. If a disaster victim is thought to be at high risk because of mental health history or within-disaster experiences, that person should be asked directly about exposure to toxic stressors (Table 34,6,7). If initial screening suggests heightened mental health risk, the person should be asked further symptom-based screening questions. The authors recommend using the following screening questionnaires: a two-item patient health questionnaire for depression (PHQ-2; 96 percent sensitivity; Table 4)27; a four-item primary care PTSD screen (PC-PTSD [this test can be viewed at http://www.ncptsd.va.gov/ncmain/ assessment/ptsd_screening.jsp]; 78 percent sensitivity)28 ; and the four-item CAGE questionnaire for alcohol abuse (75 to 97 percent sensitivity).29-32 Relatively high sensitivity rates suggest that very few people with post-disaster mental health problems will be missed by screening (i.e., low false-negative rate). Positive screening results should be followed up with additional diagnostic interviews and intervention as appropriate.25,33-35 Disaster Preparation The authors propose a four-step disaster preparation plan so that when disasters happen, family physicians are able to turn their collective knowledge and skills into compassionate and competent action. This plan includes education, linking up with other organizations, logistical preparation, and personal preparation. 844 American Family Physician Certain experiences during disasters are thought to increase the risk of developing anxiety, depression, or other similar problems. To best help you, may I ask a few questions about how you were affected by the disaster? During or immediately following the disaster: • Did you ever fear that you might be seriously injured or killed? • Were you or was anyone close to you seriously injured? • Do you know anyone who died? • Were you separated from anyone in your immediate family? • Was your home seriously damaged or destroyed? note: Positive responses should prompt further exploration. *—Degree of within-disaster exposure directly determines risk of developing post-traumatic stress disorder, depression, or other severe mental health problems. Table 4 Patient Health Questionnaire (PHQ-2) for Depression Screening*† How often over the past two weeks have you experienced either of the following problems: 1. Having little interest or pleasure in doing things? 2. Feeling down, depressed, or hopeless? *—“Yes” versus ”no” response format, with yes = 1 and no = 0. A score of 1 is a positive screening result with a sensitivity of 96 percent. †—Four-point response format, with 0 = not at all; 1 = several days; 2 = more than one half of the days; 3 = nearly every day. A score of 3 or more is a positive screening result with a sensitivity of 83 percent. Information from reference 27. education Family physicians should educate themselves thoroughly about disaster-related physical and mental health threats. There are many articles and books available.6-8,33-36 Many Web sites also provide information about disaster-related resources and service opportunities (Table 5). All physicians should know about threats that may impact a community, including bioterrorism, terrorism, and mass casualty events. Physicians within certain geographic regions also should educate themselves regarding natural disaster events particular to their area. linking Many opportunities exist to proactively apply professional knowledge and skills by becoming involved in existing disaster preparedness efforts. Because the scope of many disasters exceeds local health care capacity, it is www.aafp.org/afp Volume 75, Number 6 ◆ March 15, 2007 Disaster-Related Health Table 5 Internet Resources for Disaster Services and Disaster-Related Health Materials Organization Web address Comment American Academy of Family Physicians (AAFP) http://www.aafp.org American Medical Association (AMA) http://www.ama-assn.org American Red Cross http://www.redcross.org Centers for Disease Control and Prevention http://www.cdc.gov National Center for Posttraumatic Stress Disorder United Way of America and Alliance for Information and Referral Systems http://www.ncptsd.va.gov Type “disaster response” into the search function to obtain a listing of AAFP-related resources, which include fact-based articles, training courses, and service opportunities Type “disaster response” into the search function to obtain a listing of AMA-related resources, which include training courses, information about the health impact of disaster, summaries of current AMA disaster activities, and other Web site links “Disaster services” link provides full access to Red Cross disaster activities, which include related news stories and tips on preparedness and coping with disasters “Emergency preparedness and response” link provides health information on a full range of disasters; useful handouts include helping families cope with the stress of relocation, tips for talking about disasters, and s ... 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