Using the cmist model to develop evidence-based practice: A study from shelters in hurricane sandy

Over many years, disparities and inconsistencies have been reported in identifying and meeting client needs for support in disaster shelters. Systems of intake that rely on self-report of needs, or instruments based on medical need are insufficient to reach the range of the whole community. Initially pilot tested in Hurrican Isaac, and used widely during Hurricane Sandy in shelters in New York, an access and functional needs model called CMIST was utilized to assess shelter populations. Communication, Maintaining health, Independence, Saftey/Support/Self-determination, and Transportation needs were assessed by licensed health care providers( primarily registered nurses)using a job action guide to assure that all areas of functional support were included. Using interview and case study methodolgy, data gathered from eight shelters demonstrated 70% of clients interviewed had needs related to Maintaining Health with the rest of the need scattered amongst the other four categories. Needs included managing chronic medical conditions in order to prevent diminishing health such as replacing medications, as well as support of function such as access to meals, mobility, appropriate sleeping support and emotional health care. Once durable medical equipment, appropriate cots and consumable medical supplies were obtained, the most requested resource was for personal assistance services or certified nursing assistants. The ability of a community to recover from disaster is linked to the post-disaster health of individuals impacted by the disaster. Early identification and support of client needs in shelters can diminish morbidity and contribute to enhanced personal and community recovery. The CMIST model contributes to this process.