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Pediatric Disaster Behavioral Health (PDBH) Toolbox

3. The Toolbox - Implementation & Tactical Resources

3.10. Primer on Professional and Personal Wellness Considerations

A comprehensive professional and personal wellness plan should be in place within health care organizations, such as clinics and hospitals, as part of emergency response procedures. This primer provides an overview of some key considerations followed by a table of potential staff wellness approaches by organizational level.

Key Considerations for Staff Support

Staff symptoms and reactions can be influenced by many factors, including but not limited to incident and personally specific impacts:

  • Type: human-caused disasters are often more psychologically challenging than natural disasters
  • Onset: was there warning and time to prepare (e.g., hurricane) or sudden onset (e.g., earthquake)
  • Proximity: Was the provider/responder in direct or close proximity to the hazard? Did they or loved once experience harm/injury?
  • Severity / Duration: How significant in severity and duration was the event? Did the provider/responder experience deaths of peers, immediate family, or friends? Did the provider see or treat, for example, mutilated or burned children? How quickly was the threat reduced or removed? Did the event (or surge related to the event) last for hours, days, weeks, or more? 

There can be difficulties when staff themselves are also survivors of the event, needing to manage dual roles within the context of the disaster. Previous history, either personal or related to other traumatic experiences can contribute to increased stress/adverse impact.

  • For example, have providers/responders had direct prior experiences:
    • Previous Disasters
    • Adverse Childhood Experiences (ACES)
    • Previous trauma, preexisting distress, and/or behavioral health disorders
    • Does the provider/responder have limited support networks

Individual provider and responder resilience can be increased, mitigating some of the risks associated with their roles and responsibilities. One example is Anticipate.Plan.Deter, which uses a “stress inoculation” and “active coping” approach to train providers in planning for, monitoring, and mitigating their risk.

  • Anticipate: Consider potential impacts you and your family will face as a responder in any disaster and identify common stress markers. What are typical signs of stress for you?
  • Plan: Plan for how you will handle expectable stress for you and family and consider adding additional coping tools and strategies. What coping tools have worked well? Do you need to add additional tools?
  • Deter: Manage expectable risk during a disaster by utilizing your personal coping and resilience plan, and self-monitoring for traumatic exposure risks related to your role, with automated feedback from PsySTART-R via SMS text link. 

Table of Staff Support Actions by Organizational Level 

Examples can be structured based on three levels: the individual / provider level, health system leadership level (CNOs, other clinical and hospital leaders), and organizational level. See examples in table below.111 Existing plans also provide recommendations for workforce well-being, such as the National Plan for Health Workforce Well-Being.

Planning and preparedness
Individual Awareness of and planning for personal risks related to health care work in disasters including Moral Injury, Burnout, Compassion Fatigue, Acute Stress and PTSD through the development and use of a formal plan to address risks.
Leadership Modified shift schedules for teams who are mobilized or activated in response.
Hospital / Clinic / Organization Access to necessary equipment (PPE) is prioritized. Provider/clinician behavioral health is included in response communications from the onset of the event.
Personal coping and wellbeing
Individual Development and practice of a personal coping plan based on small-scale healthy choices.
Leadership Clear and transparent messaging around known and unknowns relative to the incident on a regularly occurring schedule (i.e., weekly, not just ad hoc communications). It's ok to say, "I don't know but I'll try to find out."
Hospital / Clinic / Organization On-site childcare support or direct childcare for staff. Acknowledgement on a system-wide level of risks, challenges, and available supports for all staff.
Communication and support
Individual Communication to leaders about what would be valued in terms of both support and reward or appreciation.
Leadership Clear process and individual contact points identified as information gatekeepers for the system (staff know who to ask about what issue).
Hospital / Clinic / Organization Resources (i.e., meals) and FAQs for employee families about any/all known risks and precautions relative to exposures at work (CBRN and pathogens) to reduce hearsay and rumors.
Peer support and behavioral health education
Individual When you have the energy, reach out to colleagues to check in with them; engage in active listening to understand more about their experiences.
Leadership Transparent information sharing about behavioral health risks and protective factors for clinicians and what happens neurologically when we experience long-term high-level stress in the context of a large-scale disaster.
Hospital / Clinic / Organization Reinforcing the cultural norm of prioritizing mental and behavioral wellness for clinicians and other medical staff by prioritizing concrete resources and programming and leadership modeling (not just messaging).
Recognition and appreciation
Individual —
Leadership Awareness of how staff prefer to be appreciated and how they like to be shown gratitude for their work and efforts.
Hospital / Clinic / Organization Support for leadership to model personal healthy active coping choices (time off, schedules, family, or childcare etc.).