HHS Pandemic Influenza Plan  Supplement 11 Workforce Support: Psychosocial Considerations and Information Needs

Healthcare institutions and state and local health agencies should consider incorporating psychosocial support services into occupational health and emergency preparedness planning for an influenza pandemic. First responders and essential service workers employed by companies and local governments (Box 2) might also benefit from these services. Healthcare and public health planners should also contact community-based organizations and nongovernmental organizations to determine the types of psychological and social support services and training courses available in their jurisdictions.

• Healthcare and public health officials should consider needs for information sharing with emergency planners in schools, law enforcement agencies, and local businesses.
• Planning for the provision of psychosocial support services might include the following activities:
  • Ensuring that administrators, managers, and supervisors are familiar with and actively encourage the use of tools and techniques for supporting staff and their families during times of crisis (see S11-IV.A and Appendix 3)
  • Training staff in hospitals and occupational health clinics (e.g., social workers, psychiatrists, nurses, psychologists, counselors) in behavioral techniques to help employees cope with grief, stress, exhaustion, anger, and fear during an emergency (see S11-IV.A and Appendix 3)
  • If feasible, providing training in psychological support services to persons who are not behavioral health professionals (e.g., primary-care clinicians, emergency department staff, medical/surgical staff, safety and security personnel, behavioral health staff, chaplains, community leaders, staff of cultural and faith-based organizations)
  • Identifying additional resources that can be available to employees and their families during and after a pandemic
  • Developing strategies to assist staff who have child-care or elder-care responsibilities or other special needs that might affect their ability to work during a pandemic

Employers of response workers and providers of essential services should obtain or prepare workforce support materials (in hard copy or electronic format) for distribution during a pandemic. These materials should be designed to do the following:

• Educate and inform employees about emotional responses they might experience or observe in their colleagues and families (including children) during an influenza pandemic and about techniques for coping with these emotions (see Appendix 3).
• Educate employees about the importance of developing “family communication plans” so that family members can maintain contact during an emergency.
• Describe workforce support services that will be available during an emergency, including confidential behavioral health services and employee assistance programs.
• Answer questions about infection control practices to prevent the spread of pandemic influenza in the workplace (see Supplement 4) and employment issues related to illness, sick pay, staff rotation, and family concerns.

Healthcare institutions should be prepared to provide materials that address healthcare and training issues related to pandemic influenza (see S11-IV.B). To support these efforts, CDC, HRSA, NIH, and SAMHSA will collaborate with the Department of Homeland Security, other federal agencies, and nongovernmental organizations to identify or develop educational materials on:

• Stressors related to pandemic influenza
• Signs of distress
• Traumatic grief
• Psychosocial aspects related to management of mass fatalities
• Stress management and coping strategies
• Strategies for building and sustaining personal resilience
• Behavioral and psychological support resources
• Strategies for helping children and families in times of crisis
• Strategies for working with highly agitated patients

State and local health agencies should consider establishing workforce resilience programs that will help deployed workers prepare for, cope with, and recover from the social and psychological challenges of emergency field work. CDC has used this approach with staff members who participated in the tsunami relief effort in 2004-2005 and the Marburg hemorrhagic fever outbreak in Angola in 2005.

To prepare for implementation of workforce resilience programs to cope with the special challenges posed by an influenza pandemic, agencies should do the following:

• Plan for a long response (i.e., more than 1 year).
• Identify pre-deployment briefing materials.
• Augment employee assistance programs with social support services for the families of deployed workers (see S11-IV.C).
• Provide program administrators and counselors with information on:
  • Cognitive, physiological, behavioral, and emotional symptoms that might be exhibited by patients and their families (especially children), including symptoms that might indicate severe mental disturbance
  • Self-care in the field (i.e., actions to safeguard physical and emotional health and maintain a sense of control and self-efficacy)
  • Cultural (e.g., professional, educational, geographic, ethnic) differences that can affect communication
  • Potential impact of a pandemic on special populations (e.g., children, ethnic or cultural groups, the elderly).

Healthcare facilities and public health agencies—as well as companies and local governments that employ essential service providers—should make full use of public health techniques and communication tools that can help response workers manage emotional stress and family issues and build coping skills and resilience. These tools can include:

• Stress control/resilience teams. These teams can assist and support employees and foster cohesion and morale by:
  • Monitoring employee health and well-being (in collaboration with occupational health clinics, if possible)
  • Staffing “rest and recuperation sites” (see below)
  • Distributing informational materials (see S11-III.B).
  Stress control teams in hospitals should observe recommended infection control precautions.
• Rest and recuperation sites. Sites can be stocked with healthy snacks and relaxation materials (e.g., music, relaxation tapes, movies), as well as pamphlets or notices about workforce support services.
• Confidential telephone support lines staffed by behavioral health professionals
• Services for families. Services to families of employees who work in the field, work long hours, and/or remain in hospitals or other workplaces overnight might include:
  • Help with elder care and child care
  • Help with other issues related to the care or well-being of children
  • Provision of cell phone or wireless communication devices to allow regular communication among family members (see S11-III.B)
  • Provision of information via websites or hotlines
  • Access to expert advice and answers to questions about disease control measures and self care.
• Information for commuters. Workers might need alternative transportation and scheduling (e.g., carpooling, employer-provided private transportation, alternate work schedules during off-peak hours) to avoid exposure to large groups of potentially infected persons.
• Services provided by community- and faith-based organizations. Activities of these organizations can provide relaxation and comfort during trying and stressful times.

A list of additional resources is provided in Appendix 3.

During an influenza pandemic, state and local health agencies should consider implementing workforce resilience programs that meet the special needs of deployed workers—including workers who do not change job site but whose assignments shift to respond to the pandemic—and the central operations personnel who support them around the clock. First-responder or nongovernmental organizations that send employees or volunteers to assist patients at home or in hospitals might establish similar programs. Workforce resilience programs could provide the following services:

Include psychosocial issues in planning

• Incorporate psychosocial support services into emergency preparedness planning for an influenza pandemic.
• Coordinate with business, corporations and other private sector interests in planning for behavioral health response and consequences.
• Develop plans to prepare and support emergency service responders (e.g., police, fire, hospital emergency department staff, mortuary workers) during and following deployment.
• Prepare for a significant surge of individuals who fear they may be infected, but aren’t, who may present at emergency departments or other healthcare locations, or contact health information hotlines.
• Develop a demographic picture of the community (e.g., ethnic, racial, and religious groups; most vulnerable; special needs; language minorities) and plan for how they might be reached in a disaster.
• Identify rest and recuperation sites for responders. These sites can be stocked with healthy snacks and relaxation materials (e.g., music, relaxation tapes, movies), as well as pamphlets or notices about workforce support services.
• Develop confidential telephone support lines to be staffed by behavioral health professionals.
• Use behavioral health expertise to develop public health messages, train staff on the psychological impact of the use of personal protective equipment (PPE), and conduct other relevant activities.

Identify and access existing resources

• Work with community-based organizations and nongovernmental organizations to determine the types of psychological and social support services and training courses available in their jurisdictions.
• Establish public-sector links with private mental health resources such as Red Cross and other national voluntary organizations active in disasters.
• Develop a plan to manage offers of assistance and invited/uninvited volunteers.
• Identify gaps, such as culturally competent and multilingual providers, that might affect disaster services.

Train behavioral health and related professionals in disaster response strategies

• Train behavioral health staff in hospitals, clinics, and related agencies in techniques to help people cope with grief, stress, exhaustion, anger, and fear during an emergency.
• Train nonbehavioral health professionals (e.g., primary-care clinicians, safety and security personnel, community leaders, and staff of cultural- and faith-based organizations) in basic psychological support services.
• Establish links to health and medical entities for purposes of assisting in screening potential victims for mental disorders and psychogenic symptomatology, functional impairment, substance abuse, etc.

Develop resources and materials

• Prepare educational and training materials on psychosocial issues for distribution to workers during an influenza pandemic.

During the first 4 weeks

• Meet basic needs such as food, shelter, and clothing.
• Provide basic psychological support (psychological first aid).
• Provide needs assessments.
• Monitor the recovery environment (conducting surveillance).
• Provide outreach and information dissemination.
• Provide technical assistance, consultation, and training.
• Foster resilience, coping, and recovery.
• Provide triage.
• Provide treatment.
• Provide psychological and social support services for employees and their families.
• Address stigmatization issues that might be associated with participation in such services.
• Implement workforce resilience programs.
• Work with communications experts to shape messages that reduce the psychological impact of the pandemic.
• Provide medical, public health, and community partners with educational and training materials.

During subsequent weeks

• Provide continued outreach, triage, and services.
• Monitor workforce for signs of chronic or severe psychological distress.
• Provide assistance in reintegration for workers who were deployed or isolated from work and family.