Addressing the mental health needs of victims, bystanders, and responders during and after disasters is as important as helping with their medical care. There are up to 50 psychiatric victims for every physical casualty in a disaster. While most people recover emotionally over the long term, their patterns of recovery often differ. Some have no mental health problems or have short-term stress and recover quickly, others take longer, and some seem fine early but later experience mental distress. A small percentage have more serious issues and need long term care. People with pre-existing mental health problems may deal well with a disaster, while for others it is a difficult traumatic event. The response to the Boston marathon bombings demonstrated the value of networks and collaborative practices in caring for people with mental health needs. Building upon ongoing research on the mental health response to the Boston bombings, this presentation reviews what is known about short and long term responses to disasters, people's needs, the methods of care and service delivery, and how to help people and communities become more resilient before, during, and following these events.

Purpose: Community Health Centers (CHCs) provide healthcare to millions of vulnerable Americans, including people with limited incomes or disabilities, and are tasked with providing care during and after emergencies and disasters. The Centers for Medicare & Medicaid Services (CMS) identified that CHC emergency planning is insufficient to meet community needs and proposed more stringent rules to address this gap. In response, the University of Massachusetts Medical School (UMMS) is engaged in a quality improvement project to enhance CHC emergency planning and response capacity, particularly for vulnerable populations. Methods: UMMS and stakeholders including the MA Department of Public Health, a MA CHC, and the MA League of Community Health Centers are developing a CHC emergency planning Toolkit with: (a) A CHC Emergency Plan Rating Scale to measure plan comprehensiveness; (b) A Table Top Exercise (interactive emergency simulation) to test plan effectiveness and identify gaps; and (c) An After Action/Improvement Plan to guide plan modification. Two pilot CHCs will implement the Toolkit to assess their emergency plans' functionality. Success will be determined by changes in rating scale scores before and after the activity. Findings: We will describe the collaborative process used to develop and validate the rating scale and Table Top Exercise. Metrics will include inter-rater reliability and content validity based both on the proposed regulatory requirements and expert review of rating scale elements. The After Action Improvement Plan illustrates how a CHC can use this as a quality improvement activity as well as test the functionality of their plan. Before and after metrics will illustrate the effectiveness of this activity to evaluate and improve emergency plans. Implications for policy, research or practice: By improving CHC emergency plans, the proposed project has the potential to protect the health of MA CHCs' 935,000 patients and their local communities, and also identify how CHCs can help expand resources during a medical surge caused by a disaster. If successful, this project could become a national model, with the potential to impact the over 1200 U.S. CHCs and communities.

During a disaster or public health emergency, it has been observed that certain at-risk individuals, specifically those with access and functional needs, have required additional response assistance before, during, and after an incident. This presentation describes best practices in advancing public health preparedness and promoting community resilience. ASPR's Hospital Preparedness Program (HPP) provides guidance through grants and cooperative agreements to States, territories, and eligible municipalities to improve surge capacity and enhance community and hospital preparedness for public health emergencies. To support a more sustainable and comprehensive solution, HPP focuses on building community and regional coalitions of health care providers. By including healthcare providers and supportive services for individuals with access and functional needs in emergency and public health preparedness planning, we can promote community resilience and enhance preparedness planning, response, and recovery issues for the whole community. The National Health Security Strategy (NHSS) is the Nation's comprehensive strategy focused on protecting people's health in case of an emergency. The NHSS is a national strategy that defines community resilience as the sustained ability of communities to withstand, adapt to, and recover from adversity. The NHSS focuses on building and sustaining healthy, resilient communities by enhancing coordination of health and human services through partnerships and other sustained relationships. Implementation involves the integration of the access and functional needs approach through emergency preparedness, response, and recovery activities to expand and identify new models to promote community resilience and health and human services partnerships to address issues such as cultural competency and health disparities. The HHS Technical Resources, Assistance Center, and Information Exchange (TRACIE) was created to meet the information and technical assistance needs of healthcare providers, emergency managers, public health practitioners, and others working in disaster medicine, healthcare system preparedness, and public health emergency preparedness. TRACIE's Technical Resources includes collections of disaster medical, healthcare, and public health preparedness materials, searchable by keyword and functional areas. For example, Access and Functional Needs Topic Collection includes resources such as fact sheets, reports, technical briefs, toolkits, webinars, plans, guidelines, best practices, and lessons learned organized by topic area.

Purpose In April 2014, the water source for residents of the Flint, Michigan was changed from Lake Huron to the Flint River. Inadequate water treatment resulted in water contamination and resident health complaints about the smell, taste, and appearance of their tap water immediately and for months after. Their concerns were largely dismissed. This crisis is a significant stressor, contributing to health worries and government distrust within the community. Our study examines associations between water quality with perceived stress and depressive symptoms within a community sample (n=409) including Flint and Genesee County residents. Methods The Speak to Your Health Community Survey in Genesee County, Michigan, was developed through a community-based participatory research process. The 2015-2016 survey included a water quality question: “How would you rate the quality (taste, smell, appearance) of your tap water?” rated from Excellent (5) to Poor (1). Depressive symptoms were measured with the Brief Symptom Inventory (BSI-18) depression subscale, and stress was measured with the Perceived Stress Scale. Findings Those who experienced poorer tap water quality in the midst of a civil crisis over an unsafe municipal water supply reported higher levels of stress and depressive symptoms, based on linear regression analyses. Analyses controlled for socio-demographic factors. Implications for Policy, Research, or Practice Stressful events unfolded at various stages of this water crisis, requiring residents within and beyond the city to manage short and long-term stressors. These stressors may contribute to a long-term psychological stress response, and escalate other mental illness outcomes. Residents would benefit from sustained services supporting mental health.