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Letters   |    
A Role for Adult Day Health Care Centers in Earthquake Relief Efforts
Bernardo Ng, M.D.; Blanca Verdugo, Ph.D.; Ipsit V. Vahia, M.D.
Psychiatric Services 2012; doi: 10.1176/appi.ps.201200232
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Dr. Ng and Dr. Verdugo are affiliated with Alegría Adult Day Health Care Center, Calexico, California. Dr. Ng is also with the Sun Valley Behavioral Medical Center, El Centro, California. Dr. Vahia is with the Department of Psychiatry, University of California, San Diego.

Copyright © American Psychiatric Association

To the Editor: On April 4, 2010, an earthquake measuring 7.2 on the Richter scale struck the Mexican border city of Mexicali. The epicenter was 32 miles south of Calexico, California, a medically underserved border city. The earthquake displaced 84 seniors in Calexico when their assisted living facility was condemned. Existing disaster plans did not provide specific guidelines for management of displaced seniors, and relief services were limited (1). We describe actions taken by a local adult day health care center (ADHC) to assist these displaced older adults.

On the day of the earthquake, the ADHC administrators inspected the day center and established safety. On the day after the earthquake, administrators informed the California Department of Aging of displaced older adults from a local retirement facility. The next day the administrators obtained special permission from the city to access records of the displaced seniors. ADHC staff secured meals and transportation for all displaced seniors, and over the next few days 55 of them were relocated to other cities or to relatives within the county. It was determined that 29 of the displaced seniors (35%) had no access to services, and they were invited to enroll in the ADHC.

ADHC social workers identified the primary care providers of the 29 seniors and scheduled office appointments. ADHC staff also contacted pharmacies to arrange delivery of prescription medications for chronic medical and psychiatric conditions. To monitor trauma-related changes, social workers assessed broad mood and cognitive status daily with open-ended questionnaires. Included were questions such as “How are you feeling?” “Do you know today’s date?” “What is the name of the place you are in?” Social workers also facilitated discussions with the displaced seniors about their personal experiences of the earthquake and adaptation to subsequent changes. The ADHC offered the services of a trained psychotherapist, but none of the displaced seniors utilized this service.

On day 30 we conducted extensive evaluations and noted no exacerbation of mental illness and no psychiatric hospitalizations. No psychotherapy or medication changes were required for the 29 seniors, and no new-onset psychiatric symptoms were documented.

Earthquakes and infrastructure damage pose challenges to disaster management (2,3). Psychiatric sequelae are common; however, psychiatric interventions aimed at inducing a better sense of control among survivors have been shown to improve behavioral outcomes for earthquake survivors (4). ADHCs are state regulated and have multidisciplinary treatment teams, including physicians, nurses, certified nursing assistants, physical and occupational therapists, psychotherapists, social workers, and activity specialists (2). ADHCs are equipped for concrete problem solving (finding shelter for displaced persons, securing basic needs, and managing disputes), and they offer a platform for medical and psychiatric care, thus helping to engender a sense of control among survivors (5). No guidelines outline a specialized role for ADHCs in disaster management plans, but our experience points to a role for ADHCs in community disaster response.

This project was partly supported by Sun Valley Behavioral Research Center; the Stein Institute for Research on Aging at the University of California, San Diego; and the John A. Hartford Foundation. The authors thank Joel Dimsdale, M.D., for help and encouragement.

The authors report no competing interests.

Mollica  R;  Hendrickson  L: Home and Community Based Long-Term Care: Recommendations to Improve Access for Californians. Sacramento, California Health and Human Services Agency, California Community Choices, 2009. Available at www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/REPORT Final Word Format.doc. Accessed Dec 26, 2011
 
Fullerton  CS;  Reissman  DB;  Gray  C  et al:  Earthquake response and psychosocial health outcomes: applying lessons from integrating systems of care and recovery to Haiti.  Disaster Medicine and Public Health Preparedness 4:15–17, 2010
[CrossRef] | [PubMed]
 
Wang  X;  Gao  L;  Zhang  H  et al:  Post-earthquake quality of life and psychological well-being: longitudinal evaluation in a rural community sample in northern China.  Psychiatry and Clinical Neurosciences 54:427–433, 2000
[CrossRef] | [PubMed]
 
Salcioğlu  E;  Başoğlu  M;  Livanou  M:  Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement.  Behaviour Research and Therapy 45:2268–2279, 2007
[CrossRef] | [PubMed]
 
Silove  D;  Steel  Z:  Understanding community psychosocial needs after disasters: implications for mental health services.  Journal of Postgraduate Medicine 52:121–125, 2006
[PubMed]
 
References Container
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References

Mollica  R;  Hendrickson  L: Home and Community Based Long-Term Care: Recommendations to Improve Access for Californians. Sacramento, California Health and Human Services Agency, California Community Choices, 2009. Available at www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/REPORT Final Word Format.doc. Accessed Dec 26, 2011
 
Fullerton  CS;  Reissman  DB;  Gray  C  et al:  Earthquake response and psychosocial health outcomes: applying lessons from integrating systems of care and recovery to Haiti.  Disaster Medicine and Public Health Preparedness 4:15–17, 2010
[CrossRef] | [PubMed]
 
Wang  X;  Gao  L;  Zhang  H  et al:  Post-earthquake quality of life and psychological well-being: longitudinal evaluation in a rural community sample in northern China.  Psychiatry and Clinical Neurosciences 54:427–433, 2000
[CrossRef] | [PubMed]
 
Salcioğlu  E;  Başoğlu  M;  Livanou  M:  Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement.  Behaviour Research and Therapy 45:2268–2279, 2007
[CrossRef] | [PubMed]
 
Silove  D;  Steel  Z:  Understanding community psychosocial needs after disasters: implications for mental health services.  Journal of Postgraduate Medicine 52:121–125, 2006
[PubMed]
 
References Container
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