Abstract
Understanding Associations between Hurricane Harvey Exposure and Symptoms of Stress and Anxiety
Rebecca Schwartz, PhD, Kristin Bevilacqua, MPH, Samantha Schneider, BA, Maria Guzman, BA and Rehana Rasul, MA, MPH
Northwell Health, Great Neck, NY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
background: Hurricane Harvey made landfall on August 25, 2017 and resulted in widespread flooding in Houston and the surrounding areas. An estimated 39,000 people were displaced and 82 people were killed by the storm in the US. Previous research underscores the profound impact that a hurricane has on the mental health of the affected residents. This study aimed to explore the associations between exposure to Hurricane Harvey and various mental health symptoms.
methods: Self-reported demographics, hurricane exposure and mental health symptomatology were obtained from residents of the greater Houston area through convenience sampling for a pilot study from 1/25/18 to 1/29/18 (N= 161). Mental health outcomes, using validated instruments, included perceived stress (Perceived Stress Scale (PSS)) and anxiety (GAD-7 scale) symptom scores. Average age of the sample was 44.58 years (SD=13.46). 43.48% identified as Black/African American and 32.92% as White. 23.60% identified as Hispanic. A majority had greater than a high school education (75.78%) and were born in the US (80.75%). Approximately 20% indicated a previous history of mental health and 9.94% were currently being treated. Multiple linear regressions were performed to determine the effect of the number of hurricane exposure items and mental health outcomes.
results: Data analysis is ongoing. Preliminary analyses found that the median number of hurricane exposure items was 4 (IQR: 2-7). Participants most frequently indicated having difficulty commuting (42.24%) and losing power/electricity (35.40%). 6.21% and 7.45% had a friend who died or was physically harmed, respectively. Mean PSS score was 16.46 (SD=6.78) and mean anxiety symptom score was 4.65 (SD=4.88). Increased exposure to Hurricane Harvey was positively associated with stress (adj. B=0.35, SE=0.14, p= .015) and anxiety (adj. B=0.35, SE=.10, p= .001), after controlling for demographic factors and mental health history.
conclusions: Higher levels of exposure to Hurricane Harvey were associated with increased PSS and anxiety symptoms. These findings are a first step in assessing the mental health impact of Hurricane Harvey in the Houston area and suggest the potential for mental health outreach following exposure to Harvey. Further data analysis will focus on depression and post-traumatic stress symptoms experienced by participants.
Advocacy for health and health education Provision of health care to the public Public health or related research Social and behavioral sciences
Abstract
Self-sustaining community kitchens as a model for increased social connectedness and community empowerment after Hurricane María
Sarah Huertas Toro, MD, MPH1, Justo Méndez Arámburu1, Belines Ramos, JD1 and Vanessa Torres-Llenza, MD2
(1)VamosPR, San Juan, PR, (2)George Washington University, Washington, DC
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Context: Vamos Puerto Rico (VamosPR) is a community-based organization founded in San Juan, Puerto Rico in 2015. Their mission is to educate, facilitate collective organization and pursue social well-being, prosperity and happiness. On September 20, 2017, Puerto Rico was hit by a Category 4 hurricane (Hurricane María) that left the island without power, water, access to food, and, for some, even shelter. After the hurricane, VamosPR quickly mobilized to assess needs of the community. This led to the establishing of community kitchens in various municipalities, with the goal of empowering communities through cooking. These community kitchens, known as Centros de Apoyo Mutuo (“Mutual Support Centers,” or CAMs), implemented community-driven programs for self-sustaining food delivery during the acute stage post-hurricane.
Description: CAMs promote local reliance on internal capabilities, rather than dependence on external resources. This was particularly essential during the acute stage post-hurricane, during which individuals suffered emotional distress and resource scarcities. Food and other supplies for the community kitchens were obtained through monetary donations and the “pooling” of resources by individuals directly impacted by the storm. In order to promote a self-sustaining center, community members prepared warm and healthy meals or helped with cleaning. Community members were also encouraged to bring their own plates and cups, promoting conscientious environmental practices. CAMs continue to provide services as part of continued recovery efforts, through the volunteer efforts of community leaders and other community members.
Lessons Learned: Six CAMs have been established in north, east, center and west of Puerto Rico, with over 2,000 participants from 18 municipalities having benefited from the program. CAMs have fostered a sense of self-reliance and unity among members. These community kitchens have also empowered community members, increased social connectedness, and motivated individuals to implement new community-led projects, such as the implementation of a clothing store managed by community members.
Recommendations/Implications: Community kitchens are a self-sustaining way to provide food to various communities in recovery post-disaster, moving individuals away from co-dependence and towards empowerment. These programs also offer a platform for social connectedness for individuals impacted by the storm and suffering distress in its aftermath.
Other professions or practice related to public health
Abstract
Children’s Mental Health in Emergency Response and Disaster Recovery: Experiences and Lessons Learned in the 2017 CDC Hurricane Response
Robyn Cree, PhD1, Jessica Franks, MPH, CHES2, Amy Wolkin, MSPH, PhD2, Rebecca Leeb, PhD2 and Lori Peek, PhD3
(1)U.S. Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)University of Colorado-Boulder, Boulder, CO
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Context: The stress and trauma that children experience from natural disasters, such as hurricanes and floods, can lead to symptoms of severe psychological distress, including depression, anxiety, behavioral issues, post-traumatic stress, or attention difficulties that can be short-term or enduring. The type of disaster (intentional and violent, technological, or natural), child’s physical proximity to the disaster, level of child distress at the time of the disaster, and personal loss of or separation from a loved one are affect mental health problems. Children with genetic risk factors, a history of adverse childhood experiences, and a history of mental disorders are particularly vulnerable to additional sources of stress. Attention to children and their mental health needs following a disaster is necessary to target interventions and improve outcomes for all children.
Description: As part of the 2017 Hurricane Response, the Centers for Disease Control and Prevention (CDC) established the At-Risk Task Force (ARTF) within the Emergency Operations Center Incident Management System to ensure identification and prioritization of the mental and physical health needs of at-risk populations, including children. ARTF collaborated with federal and non-government partners to address the mental health needs of children. Key activities included monitoring behavioral health in affected areas, disseminating key messages and stress management resources for children in schools and communities, and hosting a webinar for primary care physicians to learn how to identify common adjustment difficulties in children, provide practical strategies to promote effective coping skills in children and their parents, and explain the importance of provider self-care.
Lessons Learned: Mental and behavioral health needs of children were a prominent concern in hurricane-affected areas, but a gap remains in real-time information on mental health needs. Timely and accurate surveillance data canto inform intervention efforts to improve developmental outcomes for children in the longer-term aftermath of disasters.
Recommendations/Implications: Public health professionals play an essential role in supporting emergency preparedness and response for children, including addressing short-term and enduring mental health needs. It is important that mental health surveillance be included in preparedness planning so that surveillance systems can be established or leveraged immediately when emergency response begins.
Public health or related public policy Social and behavioral sciences
Abstract
Behavioral Health Rapid Assessments for Post-Disaster Settings
David Abramson, PhD, MPH1, Emily Goldmann, PhD, MPH2, Rachael Piltch-Loeb, MSPH1 and Amila Samarabandu3
(1)New York University, New York, NY, (2)New York University School of Global Public Health, New York, NY, (3)NYU College of Global Public Health, New York, NY
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background
Natural, man-made, and technological disasters are often associated with structural, economic, and population disruptions which lead to short- and long-term mental health consequences in adults and children. Although there are a number of rapid assessment and survey instruments for assessing post-disaster mental health status, there is no single parsimonious survey instrument to recommend for use by applied epidemiologists in rapid mental health field assessments. With funding from the Council of State and Territorial Epidemiologists, we developed a standardized validated behavioral health module for quick deployment as a stand-alone instrument or in conjunction with a broader population assessment. The objective of such a behavioral health module is to support informed decision-making and programmatic strategies for public mental health interventions following catastrophic events.
Description
To begin, our team conducted a review of previously used field rapid assessments and those described in the peer-reviewed and grey literature. Next, a taxonomy of behavioral health measures was developed. Items and scales were categorized by the psychological domains and latent constructs they were attempting to measure: for example, addictive disorders, affective disorders such as depression or anxiety, mental health distress, or functional impairment. A test module was created based upon prior validation, scale efficiency, and ease of use. In addition, the module included measures of mediating factors such as barriers to services, risk behaviors, and stress. To evaluate criterion validity survey measures were assessed in relationship to the Structured Clinical Interview for DSM-5 (SCID-5), a gold-standard diagnostic instrument. The researchers also explored different modes of assessment administration, including in-person, telephone, and self-administered. A testbed of 100 disaster-exposed individuals was drawn in part from two longitudinal disaster cohorts, one from Hurricane Katrina and the other from Hurricane Sandy. The module was tested and trimmed based on assessments with this testbed.
Implications
This module provides data to epidemiologists and public health practitioners to establish post-disaster behavioral health incidence patterns, and to support interventions that range from stress reduction, to harm reduction and counseling, to screening, referral and treatment services.
Assessment of individual and community needs for health education Epidemiology Program planning Public health or related research
Abstract
Collaborate, Communicate, Coordinate and Respond
Todd Stephenson
Alameda County Behavioral Health Care Services, Oakland, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background:
In 2017, California experienced the most destructive wildfires in state history. Sonoma and Napa counties engaged Disaster Behavioral Health (DBH) services on a scale not seen in decades. The fires affected rural and urban residents of all ages including a significant number of individuals who spoke monolingual Spanish. The provision of DBH services by multiple Bay Area counties played a critical role in supporting the behavioral health needs of thousands of evacuees relocated to dozens of shelters over a four week period.
Description:
This presentation will describe how the Sonoma and Napa county DBH response was implemented, and offer lessons learned and recommendations. Services were provided in shelters, schools and neighborhood re-entry points. DBH responders were licensed or in the internship stage of licensure. Mutual Assistance initiated by the Napa County was coordinated by the Regional Disaster Medical Health Specialist (RDMHS). This was followed by the Sonoma County mission, coordinated by Alameda County Behavioral Health Care Services. Regional collaborative committees for Northern California’s Behavioral Health and Public Health agencies coordinated an effective response by facilitating communication.
Lessons Learned:
1. Language Capacity: A significant number of evacuees spoke monolingual Spanish. Collaborate with community partners to develop interpretation services in advance.
2. Emergency Management Collaboration: Communication and resource coordination is most efficient when county departments have existing relationships with emergency management programs and familiarity with mutual assistance agreements.
3. Documentation: Documentation procedures are needed to expedite federal reimbursement.
Recommendations:
1. Language Capacity:
· Create or update county level agreements for interpretation services.
· Include contract providers and/or community partners in disaster planning.
· Consider using tablets with live interpretation applications.
2. Emergency Management Collaboration:
· Participate in county-wide emergency management meetings.
· Familiarize yourself with mutual assistance agreements.
· Collaborate with Law Enforcement and Public Health for exercise and grant opportunities.
3. Documentation:
· Expedite federal reimbursement by training responders on Incident Command System (ICS) and ICS 214 Unit (activities) log form.
· Consider using documentation guidelines in the Substance Abuse and Mental Health Services Administration (SAMHSA) Disaster Toolkit.
Administer health education strategies, interventions and programs Administration, management, leadership Diversity and culture Other professions or practice related to public health Planning of health education strategies, interventions, and programs Social and behavioral sciences
Abstract
California Reducing Disparities Project: Why Community-Defined Evidence to Improving Community Mental Health Disparities in Underserved Populations, and Are We There Yet?
Rachel Guerrero, MA1, Sergio Aguilar, Ph.D., M.D.2 and Gustavo Loera, EdD3
(1)Guerrero Consulting, Sacramento, CA, (2)UC Davis, Sacramento, CA, (3)Independent Research Consultant, Cerritos, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Context: The passage of the 2004 Mental Health Services Act (MHSA), California has been at the forefront in community capacity-building practices and creating healthy communities among the five most underserved populations in California. These five communities include: African Americans, Asian/Pacific Islanders, Latinos, Lesbian, Gay, Bisexual, Transgender, Queer and Questioning (LGBTQ) persons, and Native Americans. This project focused on the Latino population and subgroups.
Description: The California Reducing Disparities Project (CRDP) is the MHSA initiative funding these efforts. This presentation will provide an overview of the CRDP. The core aim of the CRHD project is to build on the phase one of the CRDP's continuous work using community-informed knowledge and strategies to identify gaps in treatment and services for underserved communities. At the heart of achieving this aim, is working closely with these underserved populations and give them a voice and decision-making authority in identifying and evaluating community-defined evidence practices that they consider to be culturally and linguistically appropriate to address their mental health needs.
Lessons Learned: In phase one of the CRDP project, we examined promising programs on their capacity to do community outreach, engage in meaningful engagement practices, and demonstrate evidence-based practices in serving Latino underserved communities. In phase 2, seven programs were identified and funded as community-defined evidence programs (CDEPs).
Recommendations/Implications: Future research on Latinos and mental health services is needed in a wide variety of areas to determine whether these findings would replicate themselves in different
Latino population subgroups. This is especially true for Latinos who communicate using a language other than Spanish or English (i.e., indigenous dialects such as, mixteco) and those who self-identify as being biracial or multiracial. Future research using an ethnographic method could shed more light on these concerns and strengthen the findings. One of the future directions that will advance these CDEPs is the formation of a collaborative advocacy group to design a Latino action plan outlining and prioritizing strategies to identify and work with key legislators, including the Latino Caucus and help replicate these seven programs so that equal access to affordable coverage, care, and quality of life is achieved.
Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Systems thinking models (conceptual and theoretical models), applications related to public health
Abstract
California Reducing Disparities Project Phase 1: Lessons learned for reducing mental health disparities in unserved, underserved, and inappropriately served communities
Rafael Colonna, PhD1 and Marina Augusto2
(1)California Department of Public Health, Sacramento, CA, (2)California Department of Public Health, Office of Health Equity, Sacramento, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background:
The California Reducing Disparities Project (CRDP) is an initiative of the California Department of Public Health’s Office of Health Equity, funded by the Mental Health Services Act. Launched in 2009, CRDP’s goal is to create effective systems change in California for reducing mental health disparities for historically underserved populations through a prevention/early intervention (PEI) model built on community engagement, partnerships, and capacity building. CRDP focuses on five priority populations: (1) African American; (2) Asian and Pacific Islander; (3) Latino; (4) Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning; and (5) Native American.
Description:
CRDP Phase 1, completed in 2018, develops strategies for transforming California’s mental health system and identifies community-based PEI practices in each of the five priority populations. Strategic Planning Workgroups for each of the priority populations engaged community members from across California in identifying population specific mental health issues and community-defined best practices for addressing those issues. Community data collection includes surveys, in-depth interviews, and focus groups. Phase 1 findings are compiled in five population reports and a CRDP Strategic Plan.
Lessons Learned:
CRDP’s Strategic Plan draws on the community findings from the population reports to identify five goals for reducing mental health disparities in California. (1) Increase access to mental health services by expanding options and service locations. (2) Improve the quality of mental health services by creating and supporting culturally and linguistically competent services and workers. (3) Ensure that communities are empowered and provided tools to be leaders in the public mental health system. (4) Demonstrate the effectiveness of population and culturally specific mental health PEI programs. (5) Develop an infrastructure to reduce disparities by expanding on state and local community engagement models. To achieve these goals, the Strategic Plan identifies 27 community-derived strategies.
Recommendations:
The strategies outlined in the CRDP Strategic Plan emphasize the importance of elevating cultural context in the provision of PEI services and in multi-sectoral partnerships committed to mental health systems change. Building on these strategies, CRDP Phase 2, initiated in 2016, funds the implementation and validation of population-specific community defined evidence practices for reducing mental health disparities identified in Phase 1.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Planning of health education strategies, interventions, and programs
Abstract
Racial & Ethnic Disparities in Depression Treatment Among Medicaid Enrollees
Brian McGregor, PhD, Megan Douglas, JD, Anne Gaglioti, MD, MS, FAAFP, Peter Baltrus, PhD, Jammie Hopkins, DrPH, MS, Kisha Holden, PhD, MSCR and Glenda Wrenn, MD
Morehouse School of Medicine, Atlanta, GA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background
This study explores inequities in depression treatment among African American, White, and Hispanic Medicaid enrollees. There is conflicting evidence about the intersection of income, race, depression prevalence and treatment patterns, thus this study examines rates, settings, and delivery of depression treatment among racial/ethnic subgroups, particularly low-income minority populations.
Methods
This study uses Medicaid claims data extracted from the full 2008-2009 Medicaid Analytic Extract (MAX) file obtained from the Centers for Medicare and Medicaid Services (CMS) that includes 29 states, representing 80% of all Medicaid enrollees in the US and 90% of minority enrollees. For this secondary data analysis multivariate regression analyses produced odds ratios of depression treatment. Depression treatment was defined as receiving medication, psychotherapy for depression or both. Results were computed by race/ethnicity in a model that controlled for gender, age, comorbidity, care location and provider type. The study population consists of Medicaid beneficiaries age 18-64, who were continuously enrolled for 24 months or until death and had a diagnosis of depression as defined by two outpatient or one inpatient encounters using 14 ICD-9 CM diagnostic codes for depression.
Results
Depression treatment rates were lower for African Americans and Hispanics compared to Whites, and the odds of African Americans were half that of Whites for receiving depression treatment. Age, comorbidity, provider status, and care location contributed to these differences.
Conclusions
This study contributes to the evidence on intersection of social factors and health outcomes and discusses healthcare seeking, stigma, engagement strategies, and policy drivers of racial/ethnic disparities among low-income, equally insured populations.
Chronic disease management and prevention Diversity and culture Provision of health care to the public Public health or related public policy Social and behavioral sciences
Abstract
Solano County Transformation Model: Approach, Design, and Implementation
Maria Alaniz, MA1, Tracy Lacey, LMFT2 and Sergio Aguilar, Ph.D., M.D.3
(1)University of California, Davis, Sacramento, CA, (2)Solano County, Fairfield, CA, (3)UC Davis, Sacramento, CA
APHA's 2018 Annual Meeting & Expo (Nov. 10 - Nov. 14)
Background/Context: The current implementation of the Mental Health Services Act's (MHSA) means major workforce transformation challenges for California's mental health system, which encompasses new and/or modified mental health practices and community-driven approaches. This transformation requires staff trained in new approaches to better serve historically underserved populations in mental health services. Specifically, we attend to key cultural and linguistic competencies required to successfully highlight the cultural experiences of Filipino, Latino and LGBTQ populations. These three populations were selected for this community-based project because they have historically shown more severe patterns of disparities when accessing and utilizing mental health care.
Description: The purpose of this project is to demonstrate the enhancement and use of Culturally and Linguistically Appropriate Services (CLAS) standards for a new approach of training that is relevant to the Filipino, Latino, and LGBTQ underserved communities. This project will impact services and policy through design and implementation of CLAS standards and action plans. Specifically, we intend to enhance workforce diversity, train/retrain county workforce, integrate community-defined solutions, and implement strategies tailored to these three underserved populations to improve access to services and reduce stigma.
Lessons Learned: Over 200 individuals representing Filipinos, Latinos, and LGBTQ persons participated in our qualitative data collection. Our results revealed the need for more providers: (1) who are knowledgeable and connected tot he community they are serving; (2) with the ability to translate and interpret information about treatment in the preferred language of the mental health consumer; and (3) who goes to where the communities live, study, work and worship to deliver services. Community-based solutions included community-based organizations that the communities identified as best practices.
Recommendations/Implications: The recommendations of this report suggest education and training implications for the integration of the CLAS standards that include culture-specific practices that tap into the life experiences of Latino, Filipino American, and LGBTQ communities. Four key CLAS training topics emerged from the data: (1) cultural communication; (2) culture and community; (3) workforce education and training; and (4) systemic and socioeconomic determinants of health.
Administration, management, leadership Advocacy for health and health education Assessment of individual and community needs for health education Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Systems thinking models (conceptual and theoretical models), applications related to public health