Presented by Mrs. Rosalie Kwong Sr. Clinical Psychologists
Certified Traumatologist
Corporate Clinical Psychology Services
Examples of Major Disasters
Nov 96 : Fire Incident of Garley building Jan 97: Top One Karaoke Fire Incident April 97: Mei Foo Fire Incident
Jan 98: Electric Road Fire Incident Jan 98: City Bus overturn Incident
Feb 98: Kam Sheung Road Coach Accident May 98: Shipwreck Accident
Aug 99: Aircraft overturn Sept 01: 911
Mar 03: SARS Dec 04: Tsunami
Nov 05: WTO
Fire Incidents
Garley building Nov 96
Top One Karaoke Jan 97
Mei Foo April 97
Traffic Accidents (1998)
Bus overturn Coach Accident
Ship wreck
Aircraft overturn
(1999)
911 (2001)
SARS
(2003)
Tsunami
(2004)
WTO
(2005)
Victims
Hospitalized/ discharged victims
Families/ relatives of the victims/deceased
Rescuers/ emergency personnel
Objectives of Disaster Management (Psychological Services)
Primary Goals
Mitigate impact of event
Facilitate normal recovery processes
Restoration to adaptive function
Phases of Disaster
Warning or Threat Phase
Reconstruction / Recovery Phase (Continue for years) Disillusionment
Phase
Inventory Phase Remedy /
Honeymoon Phase (Week - Months)
Rescue / Heroic Phase
(Immediate Aftermath) Impact Phase
Intervention Timeline
Incident
Crisis Intervention
Counseling
Psychotherapy
Hospitalization
Rehab
Critical Incident Support Teams (CIST)
Clinical Director
IV. 2002- present
Oasis – Center for Personal Growth &
Crisis Intervention
Center Director
III. 2001
Disaster Psychosocial Services Teams (DPST)
Chief Coordinator, HAHO Trainer
II. 1999/20
Civil Disaster Management Committee (CDMC) (Clinical Psychology Services)
Network among CPs
Chairman, Chief Coordinator
I. 1996/97
Implementation mechanisms
Psychological Management of Disaster
III. Oasis – Center for Personal Growth &
Crisis Intervention
IV. Critical Incident Support Teams
Rescuers /
Emergency Personnel HA Staff
I. Civil Disaster Management Committee
(Clinical Psychology Services)
II. Disaster Psychosocial Services Teams
1. Hospitalized / Discharged Victim 2. Family members / Bereaved relatives
Civil disaster contingency plan (clinical psychology service) Coordinators:
Clinical psychologists/ senior clinical psychologists
Better coordination of clinical psychology Services in the event of a major disaster
Network among clinical psychologists working in different clusters (not only those working in acute general hospitals)
I. Civil Disaster Management Committee
(Clinical Psychology Services) (CDMC)
I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)
Objectives:
Objectives:
To minimize the severity and duration of emotional trauma To prevent development of further mental disturbance
I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)
Scope of Services Scope of Services
Consultation on therapeutic intervention Psycho diagnostic assessment
Psychological intervention Group support session
Group debriefing
Development of psycho educational materials Training
Liaison with other agencies
I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)
1.Trauma Victims1.Trauma Victims (Adult, Children)
Chinese & Eng versions
2. Bereaved Relatives 2. Bereaved Relatives (Adult, Children, Staff)
Chinese & Eng versions
Psycho educational materials
Psycho educational materials
I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)
33
. . Emergency personnel Emergency personnel - -
Critical Incident Stress Management Critical Incident Stress ManagementRequest Forms Request Forms
Oasis website :
http://www.ha.org.hk/oasis
I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)
Training
1. Workshops on “Disaster Psychosocial Services” e.g.
Pre-incident Preparation Phases of disaster
Impact of disaster
Assessment of the needs of survivors
Management of disaster victims/ families
Service Guidelines
Assessment Forms
Disaster Psychosocial Services Record Form
Incident :
Date :
Name :
ID No.
Sex : F M
Age :
Marital Status : S M D W
Education : Nil P S U P
Contact No. :
Address :
Physical Injury :
Mental Condition :
Major Concern :
Social Support :
Services Rendered :
Action Plan :
Referral :
Prepared by (Rank )
Assessment Checklists For Disaster Victims
A. Acute Symptoms
Affective Dimension
1. Affective Flooding e.g. panicked, enraged
2. Affective Numbness e.g. absence of emotional responsiveness, reduction in awareness of the surrounding
Congnitive Dimension
1. Memory Impairment e.g. inability to recall personal information 2. Concentration Difficulties e.g. train of thought is often interrupted 3. Denial e.g. demand the dead relative gets up and returns home 4. Ruminations & Intrusions e.g. obsess with the details, repet the same
answered questions
5. Guilt and Hopelessness e.g. self-blame and expressed suicidal thoughts
Physiological Dimension
1. High Arousal Level e.g. flushed, sweating 2. Somatic Discomfort e.g. dizziness, palpitation
Behavioural Dimension
1. Withdrawal & Avoidance e.g. turn away from people 2. Regression e.g. speak and act like a child 3. Aggression to self or others
Severe Moderate Mild
C. Trauma Risk Factors
Trauma Factors
1. Life threatening danger, extreme violence, or sudden death of others 2. Personal injury
3. Loss of Loved ones 4. Injury of loved ones
5. Extreme loss or destruction of their homes normal lives, and community 6. Exposure to traumatic sights, sounds, or experiences
7. Witness of mass destruction or death 8. Histories of prior exposure to trauma
Support
1. Low levels of emotional / social support or high levels of social demand
Coping
1. Coping via avoidance, self-blame, or rumination 2. Coping via substance abuse
Comorbidity
1. Previous experience of adverse life events 2. Eventful developmental history and family instability 3. Prior psychiatric / severe emotional disturbance 4. History of substance abuse
5. History of suicidal attempt
6. Major life stressors (e.g. divorce, job loss, financial losses)
7. Prior significant loss (e.g. death of a loved one in the past year), unresolved bereavement
8. Loss of job 9. Toxic contamination
10. Serving as an emergency worker (e.g. police, fire, healthcare, professionals, emergency workers)
11. Elderly
Severe Moderate Mild
Grief Risk Factors (Adult)
Risk Factors
1. Having young Children
2. Low socio economic status
3. Unemployed or with financial difficulties
4. Presence of rage
5. Blaming others
6. Blaming self
7. Poor social Support
8. Inadequate coping skills
9. Multiple losses
10. Prior psychiatric / severe emotional disturbance
I. Civil Disaster Management Committee (Clinical Psychology Services) (CDMC)
2. Training for HA staff who are required to provide direct services to disaster victims or their relatives e.g.
“Acute grief handling”
“Breaking bad news”
“Understanding critical incident stress”
I. Civil Disaster Management Committee (Clinical Psychology Services)
Liaison with other agencies
Indirect peripheral victims
Victims without physical injury
Who are in need of psychological treatment
Referral to other relevant agencies for FU services
SWD
NGOs
Universities: Psychological services unit
II. Disaster Psychosocial Services Teams
(DPST) (14 Acute General Hospitals)
TMH NTWC
AHNH, NDH, PWH NTEC
CMC, KWH, PMH,YCH KWC
TKOH, UCH KEC
QEH KCC
QMH, RHTSK HKWC
PYNEH HKEC
- HAHO
Hospitals
Cluster
II. Disaster Psychosocial Services Teams
(Coordinators)
Clin. Psy.
Ms. Ide Chan TMH
NTWC
PR&PAS Ms. Terry Wu
NDH
MSW Mr. Victor Tam
AHNH
MSSU Ms. Tam Chui-king
PWH NTEC
Clin. Psy.
Dr. Kitty Wu CMC
MSS Ms. Kitty Fu
YCH
MSS Ms. Lee Mee-ling Florence
KWH
PSD Ms. Kitty Siu
PMH KWC
MSS Ms. Tsoi Yuen-kan
UCH
Psychological Spiritualf Reh.
Center Mr. S. Y. Li
TKOH KEC
Clin. Psy.
Ms. Mary Lee QEH
KCC
MSW Mr. Tse Heung Sang
RHTSK
Clin. Psy.
Dr. Amy Fung QMH
HKWC
Clin. Psy.
Ms. Jeanie Ngan PYNEH
HKEC
PS&O Ms. Rosalie Kwong
- HAHO
Department Name
Hospitals Cluster
II. Disaster Psychosocial Services Teams (DPST)
Members:
Clinical Psychologists Medical Social Workers Pastoral care workers Chaplains
Patient relation officers Community nurses
etc.
II. Disaster Psychosocial Services Teams
Disaster Psychosocial Services Team (DPST) (MSWs, Clinical Psychologists, Chaplains,
Pastoral Care Workers, PROs, Nurses, etc…)
Initial Assessment
Immediate Intervention
Identification of Patient at Risk
Referral FU
II. Disaster Psychosocial Services Teams
Scope of services (Psycho social spiritual care) Scope of services (Psycho social spiritual care)
Assessment
Crisis intervention Assisting in help Desk Bereavement counseling
Spiritual care, sacramental services, religious services/rituals
Follow up services (including home based Fu visits) Making referral
Consultation services to other health care workers Liaison with other departments
Critical Incident Support Teams (CISTs) Crisis Intervention
IV.
Oasis – Center for Personal Growth & Crisis Intervention Psychological services for staff
III.
Disaster Psychosocial Services Teams (DPST) II.
Civil Disaster Management Committee (CDMC) (Clinical Psychology Services)
I.
Emergency Personnel
Implementation mechanisms
“Hidden Victims”
Emergency personnel Health care workers
Secondary/ Tertiary victims Vicarious traumatization
Empathy : suffering and distress Exposure
Normal reaction to abnormal situation
Possibility of developing PTSD Emotional Symptoms
Emotional Symptoms: Depressed mood, anxiety, irritation, hypervigilance, etc.
Cognitive Symptoms
Cognitive Symptoms: Sense of detachment, recurrent thoughts or dreams of the incident, poor concentration, difficulty in making decisions, etc.
Behavioural Symptoms
Behavioural Symptoms: sleeping difficulty, avoidance
behaviours, poor appetite, loss of interest in work, substance abuse, etc.
Physical Symptoms
Physical Symptoms: Headaches, fatigue, dizziness, etc.
Impact: Individual Level
Impact: Organizational Level
↑ absenteeism
U.S. : lost workdays per nonfatal assault = 5
↓ work performance
↓ sense of organizational commitment
↑ staff turnover
↑ number of accidents at work
↑ long-term treatment cost
Post-incident Support
Proper support to staff: Standard of care
Care for staff
Care for Patients
Service Providers
III.
III. Oasis Oasis – –
Center for Personal Growth & Crisis InterventionCenter for Personal Growth & Crisis InterventionCorporate Clinical Psychologists Psychological services to HA staff
Website:
http://www.ha.org.hk/oasis
Psychological Wellness
1. Direct Clinical Services
2. Crisis intervention-- psychological “first aid”
3. Professional Training 4. Research/ Stress Audit 5. Consultation Services
6. Personal Development Programs 7. Oasis at Workplace
8. Development of Resources 9. Volunteer Services
10. Facilities of Oasis: bookstore, resources Library
III. Oasis
III. Oasis – – Center for Personal Growth & Center for Personal Growth &
Crisis Intervention Crisis Intervention Scope of Services
Scope of Services
Personal Development → Crisis Intervention
1. Contingency Plans of Major Critical incidents—Psychological services for staff (e.g. SARS, WTO, Avian Flu Pandemic)
2. Phases of intervention:
Pre-event Stage Event Stage
Post-Event Stage
3. Pre-incident training: Psychological preparedness 4. Critical Incident Stress Management (CISM):
various intervention approaches
III.
III. Oasis Oasis – – Center for Personal Growth & Center for Personal Growth &
Crisis Intervention Crisis Intervention Crisis intervention
Crisis intervention -- -- psychological psychological “ “ first aid first aid ” ”
Different hospitals
Staff volunteers from different disciplines
(e.g. physicians, nurses, allied health professionals, administrative, support services,)
Trained under the Critical Incident Stress Management model
Supported by Corporate
Clinical Psychology Services
Peer-led support system
IV. Critical Incident Support Teams
Psychological First Aid
Critical Incident Support Team
Physicians, Nurses, AH SSP, Admin P
Assessment
Intervention
Oasis
(Corporate Clinical Psy Services)
NTW
談德榮先生 Mr Victor Tam 雅麗氏何妙齡那打素醫院 40
大埔醫院
陽光行動
NTE招潔萍小姐 Ms Canice Cheiu 何沛儀小姐 Ms Becky Ho 威爾斯親王醫院 28
緊急事故 支援小組
Ms Florena Yau 聖母醫院 21
明愛醫院
心聆夥伴
Ms Grace Wan 仁濟醫院 8
同仁共濟
朱懿芬小姐
Ms Josephine Chu 靈實醫院 19
聆心薈
KEC何鈺瑩小姐 Ms Maicy Ho 青山醫院 29
博愛醫院 小欖醫院 屯門醫院
知心友
沙田醫院 16
沙田慈氏護養院 白普理寧養中心
晴心苗圃
劉洪漪小姐 Ms Liu Hung-yee 廣華醫院 31
東華三院黃大仙醫院
同路人
陳貴芳小姐 Ms Pamela Chan 瑪嘉烈醫院 21
心聆之友
KWCMs Kwok Wai Han 律敦治醫院 18
Ms Ann Chan 東區尤德夫人那打素醫院 26
HKE
聯絡專員 小組人數
醫院 聯網
緊急事故 支援小組
Critical Incident Support Teams (CIST)
Crisis Intervention Services
Model of Critical Incident Stress Management (CISM) (Everly & Mitchell, 1997, 1999)
A comprehensive integrated, multi-component continuum approach to crisis intervention
Scope of Services Scope of Services
I. I. Pre-Pre-ExposureExposure
Formulation of CISM team Stress Education
II. During Traumatic ExposureII. During Traumatic Exposure
“On Scene” Support Services
III. Post Stress Intervention III. Post Stress Intervention
1. Crisis Mx Plan/ Strategic Response to Crisis
Assess service needs
Psychological triage
Set expectations
Advice and plan suitable crisis intervention services
Scope of Services
2. Individual crisis intervention 3. Small group crisis intervention
a. Defusing
b. Critical Incident Stress Debriefing (CISD)
Scope of Services
4. Large group crisis intervention
a. Demobilizations
b. Crisis Management Briefings
5. Consultation
Scope of Services
“It helps to build up a harmonious atmosphere among staff”
“The group meeting can relieve my anxiety”
“I can get professional advice from the facilitator”
“It is good for my mental health”
“I realise that I am not alone”
“I do not have to face the problem alone”
“Members can know more about each other’s feeling”
“It helps to understand the impact of this incident on my psychological well being”
Feedback from Staff
Psychological Services for Other Government Personnel
Lan Kwai Fong Incident
(firefighters, ambulance men)
Aircraft overturn (air traffic controllers)
Immigration Tower Incident (officers)
Tsunami (government personnel)
Psychological Services for Other Government Personnel
Immigration Dept.
Hong Kong Police Force Auxiliary Medical Services Civil Aid Services
Hospital Authority Department of Health
Government Information Service
Security Bureau
Social Welfare Department
Consultation to management
Group Crisis Intervention (Critical Incident Stress Debriefing)
Psycho education class Individual follow up
Psycho educational material on “Coping with Critical Incident Stress”
