“Helping People Living Better Lives” | pg. 1

Rev.6/12/2020

Department of Health and Human Services

COVID-19 Coronavirus

Guidance for Behavioral Health Workforce – COVID-19 Frequently Asked Questions

Updated June 12, 2020

Q: How can we, as behavioral health professionals, support individuals receiving care in state psychiatric hospitals?

A: Safety

Caring for the physical and psychological safety of individuals served is paramount during this crisis. Clearly the physical setting must be safe as well as the interpersonal interactions must promote a sense of safety.

Recommendations include:

● Encouragingexercisesonself-compassion,gratitude,andmindfulness.● Providingindividualsaccesstovirtualvisitationviatechnologies/programssuchasFacetime,Skype, phones,etc.● DevelopingasafetyfactsheetonCOVID-19.● Askingstaffandindividualsincarewhatwillenhancetheirpersonalsafetyatthistime.● Encouragingpeerstodeveloppersonalcomfortstrategies.● Offeringinformationalmaterialsandsessionsforpersonsservedtoeducatethemonthecrisis.● Helpingpersonsservedunderstandthedifferencebetweenisolation(confirmedpositivesorpeopleshowing

symptomsconsistentwithCOVID-19)andquarantineforpeopleexposedtoseeiftheywilldevelopsymptoms.(Thisshouldincluderegularmeetingsforinformationandquestions.)

● Explainingvariationsinprotocols(e.g.whystaffanddesignatedpatientsmustwearfacecoveringsandpeopleservedmaynot.)

Empowerment, Voice and Choice

Wheneverpossible,allowingindividualsincaretheopportunityforchoicewillprovideanincreasedsenseofcontrol.Hearingexpressedconcernsandfearsandprovidingsuggestionsforself-soothingcanreducesymptoms.

Recommendations include:

● Givingpersonsservedtheoptiontowearmasksandprovidingtheminformationonthebenefitsofusingmasks.

● Playingsoothingmusicandsoundstosoothetheanxietiesofpersonsserved.● Providingpersonsservedwithvideo-streamingservicesofrelaxingenvironments,suchaszoosorwildlife

preserves.● Engagingpeersindevelopingmeaningfulandrelaxingactivitiesontheunit(i.e.games).● Developingactivitiesforthoseinisolationthatareengagingandmeaningfultoincreaseoverallhealthand

well-being.Onewaytodothisistoaskthepersonsservedwhattheywouldliketohavetohelpcopewith the crisis.● Personsservedinisolationcontinuetoreceiveclinicalserviceseitherinpersonorvirtually.● Givingpersonsservedtheoptionstodoyogaandotheronlineexercises.● Offercreativeexpressionopportunitiestoworkthroughemotionsaboutthevirus,suchasartmaking,poetry,

or other activities that can be accomplished while social distancing.

“Helping People Living Better Lives” | pg. 2

Trustworthiness & Transparency

Duringtheseuncertaintimes,itissocriticaltomaintaintrustthroughregularcommunicationandinformationsharing.

Recommendations include:

● PresentinginformationonCOVID-19inincrements.● Providingupdatedinformationandopportunitytoprocessfeelingsisimportantincalmingescalatingfears.

Anxietyishighforeveryoneduringthisstressfultime.Peersmaywitnessanotherontheunitescortedbyoutside paramedics being transported to the hospital.

● Engaginginhonestdiscussionandallowingfearstobeexpressedcanmitigateescalatingfeelings.● Developingconcreteguidanceanddosanddon’tslistforthecrisis.● Beingtransparentwithpersonsservedaboutfeelingsandfearsoverthecrisis.● Practicingcalmingstrategiesmayalsobehelpful.Pleaseseethemindbodycalmingstrategiesattachedthat

canbeprintedanddisplayed.Theycanalsobepracticedatcommunitymeetings.● Intheunfortunateeventthatapeerontheunitdies,givingthegrouptheopportunitytogrieveandhonorthe

individual in a way that is meaningful to them.● Hostinginformationalsessionstoexplainchangesinpolicy,practice,andclinicalprogramming.Thepractice

guidelinestodealwiththisepidemicareconstantlychangingandbeingrevised.Assuch,itisimportantforpeopletounderstandwhat’sbehindthechange.

Collaboration & Mutuality

EveryonehasaroletoplayduringtheCOVID-19crisis.Personsservedandpersonsservingareallexperiencingfear,anxietyanduncertainty.Wearetrulyinthistogetherandyoudon’thavetobeatherapisttobetherapeutic!

Recommendations include:

● Creatingawarmlineforpersonsservedtocalltodiscusstheirownexperiencesandreceiveinformationconcerning the virus.

● Createa“copingkit”composedofstressmanagementandcopingstrategiesfavoredbystaffandpersonsserved.

● Hostingconsistentmeetingstogetherwithstaff,peersupport,andclientsonupdatesconcerningtheCOVID-19crisis.Ideally,thisshouldbedonevirtuallythroughprogramslikeZoomandWebEx;anditshouldendwithabreathingexercise.

● Usingvirtualmeetingstotransitionpersonsservedoutofstatehospitalsintocommunitysettings.● Holdingmorning(daily)check-ins/communitymeetingstospeakwithandcheckonthestatusofpersons

served.Providingaforumforbothstaffandpeopleservedtoprovidesupporttoeachother.

Peer Support

Utilizingtraditionalin-personpeersupportmightbechallengingduringthistimeofsocialdistancing.Whatevercanbedonevirtuallywillprovideimportantconnectionwhenphysicalconnectionisnotpossible.Encouragingmutualself-helpandlearningtocareforonewouldprovideadditionalcomfortduringthisdifficulttime.

Recommendations include:

● Continuingpeersupport,eitherin-personorvirtually(dependingonthehospital’spolicies).● Providingin-unitpeerswithinformationandtools(i.e.curriculum,training)forthemtoassistotherpatients in their units.● Encouragetheuseofpeer-to-peersupportamongpeerworkersatyourfacility.

“Helping People Living Better Lives” | pg. 4

3

Cultural, Historical & Gender Issues

Familyandculturalconnectionsareimportantforthewell-beingofpersonsserved.

Recommendations include:

● Informingpatientsthatallpeoplecanbeaffectedbythiscrisis.Educatehonestlythatwhileolderpeopleareathighestrisk,evenyoungerpeoplewithpre-existingconditions,includingcurrentandformersmokersorpeoplewithdiabetes,areathighrisk.

● Encouragingindividualstosharetheirtraditional,culturalhealingritualsandvalues.● Attendingtoissuesofstigma.Mediacoverageoftenfocusesoncertaingroupsbeingmoresusceptible

toCOVID-19thanothers.Assuch,itisimportanttoprovideaccurateinformationinordertopreemptivelyaddress issues over misinformation.

We also encourage the behavioral health workforce to visit these resources and remember to practiceself-care:● Mind Body Skills(linkisexternal)● Rethinking Crisis: Crisis Strategies to move from Crisis to Empowerment(linkisexternal)● NASMHPD All Facilities Manual(linkisexternal)

May 1, 2020

Q: Guidance was requested by a provider (appeal the unit designation) and NABHO on the DBH medication management unit of service.

A:The4/9/2020BehavioralHealthFAQstatedthattheunitofserviceformedicationmanagementis15minuteswithtelehealthandthattelephoneappointmentsarenowpermissibleroutesofservicedelivery.Ingeneral,providerscontractedwiththeRegionsareencouragedtoworkwiththeRegiontohandleuniquecircumstancestothatexpectation.Thereareuniquecircumstancesforwhichtheprovidercoulddocumentone-timeoccurrencesinthemedical record.

TheDivisionofBehavioralHealth(DBH)isuncertainastothefrequencyofthemedicationmanagementunitissuebroughttoourattentionbytheprovider;however,withrespecttoappeals,unitsofserviceareacontractissuenotaregulatoryissue.Thereisanappealprocessforregulatoryissues.DBHsolicitsRegionfeedbackforcontractupdatesonanannualbasis.Atthistime,themedicationmanagementunitwillremain15minutes.

Theprovider’soriginalconversationwithDBHdidnotindicatetheconcernwasspecificallyrelatedtoCOVID-19.TheinformationsubmittedtothemailboxdidreferenceCOVID-19.DBHwillestablishaminimumof10minutestobillforone15-minuteunitduringtheCOVID-19PublicHealthemergency,effectiveApril1,2020.

Q: With the changes to delivering care virtually, are there resources that address how to best engage consumers using this route of service delivery?

A: Kenneth Zoucha, M.D., has provided the following resources to help in asking questions to patients:

Weusedifferentscreeningquestionnairesforourpatients.Oftenthosearegiveninthewaitingroomorintheroombeforetheproviderenters.Wehavestartedtodotheseon-linewiththepatients.Itdefinitelyopensupquestionsanditems/issuesthatthepatientswanttotalkabout.Alotofthespontaneityoftheencountergoesawaybytelehealth and this opens it up.

EPIC(OurEMR)hasscreeningquestionsbuiltintothem.

“Helping People Living Better Lives” | pg. 4

FirstistheSheehanDisabilityScale:http://www.cqaimh.org/pdf/tool_lof_sds.pdf

Iaskthesequestionsofthepatientsduringtheinterview.Iputitinatvarioustimesthroughouttheinterview.Itisawaytotrackimprovementovertimeaswell.Again,oftenthesequestionswillelicitotherconversationswiththepatients.

IaskthePHQ-2questions:http://www.cqaimh.org/pdf/tool_phq2.pdf

Ithasvalidityandsciencebehinditasagreattoolfordepression.IftheyarepositivethenImovetoPHQ-9:http://www.cqaimh.org/pdf/tool_phq9.pdf

Finally,IasktheGAD-4:https://www.mdcalc.com/gad-7-general-anxiety-disorder-7

Youdon’thavetoaskalloftheseeverytime,andyoucantailorittoeachindividualpatient.

AlloftheseexceptforGAD-4canbefoundforuseatthefollowingwebsite:www.cqaimh.org

Justsomesuggestions.IhavefoundthemveryhelpfulandagaintheyareinorcanbebuiltintoanEMRandscoredwhiletalkingwiththepatients.

Teresa Bledsoe, PLMHP, Community Alliance, has provided tips to help engage consumers:

Iwouldliketosharesometipsasclinicaldayrehabstaff.Wehavebeenattemptingtocontactconsumersafewtimesaweekinordertohelpthemstayontrackwithmeetinggoalsontheirdayprogramtreatmentplans.Ofcourse,thiscanbechallengingsincetheyarenotabletoengagesociallywiththeirpeersorparticipateinaclassroom/groupenvironmentrightnow.I’vebeentryingtopreserveasmuchofthataspossiblebyfindingmaterialsthatIcanuseforeducationalpurposesastheyrelatetotheconsumer’sgoals.Itrytofindmaterialsthatareinteractivewheretheconsumerhastoprovidesometypeofresponseanditwillfacilitatefurtherdiscussion.OnetoolIutilizedlastweekwas“positiveaffirmationjournalprompts”,inwhichIwouldgiveastatementlike“SomethingIlikeaboutmyselfis…”or“onethingIaccomplishedtodaywas…”.Activitieswhichengagetheconsumeraremuchmoreeffectiveandhelpustobetterassesshowtheyaredoingbasedontheirresponses.

Otherresourcesaddressingtipsandguidelinesfordeliveringonlineservicesinclude:

https://store.samhsa.gov/product/TIP-60-Using-Technology-Based-Therapeutic-Tools-in-Behavioral-Health-Services/SMA15-4924?referer=from_search_result

https://www.integration.samhsa.gov/operations-administration/practice-guidelines-for-video-based-online-mental-health-services_ata_5_29_13.pdf

https://higherlogicdownload.s3.amazonaws.com/AMERICANTELEMED/618da447-dee1-4ee1-b941-c5bf3db5669a/UploadedImages/Practice%20Guideline%20Covers/NEW_ATA%20Children%20&%20Adolescents%20Guidelines.pd

https://higherlogicdownload.s3.amazonaws.com/AMERICANTELEMED/618da447-dee1-4ee1-b941-c5bf3db5669a/UploadedImages/Practice%20Guideline%20Covers/NEW_ATA%20Children%20&%20Adolescents%20Guidelines.pd

“Helping People Living Better Lives” | pg. 4

5

https://www.integration.samhsa.gov/hit/telehealthguide_final_0.pdf

https://www.researchgate.net/publication/340066049_COVID-19_Tips_Building_Rapport_with_Youth_via_Telehealth

https://www.ncbi.nlm.nih.gov/books/NBK344045/

April 20, 2020

Supporting Emotional Health of the Behavioral Health Workforce During COVID-19Thereisnohealthwithoutbehavioralhealth.Asabehavioralhealthprovider,thankyouforyourcommitmenttoservingNebraskans.It’sessentialyoutakecareofyourselfduringthishealthcarecrisis.YouarelikelyexperiencingadditionalchallengesduringtheCOVID-19infectiousdiseaseoutbreak.Thismayincludeconcernsaboutyourownhealth,yourfamily’shealth,stigmafromwithinyourcommunity,andmanagingthedistressofpeopleyousupportinyour professional life.

Weacknowledgetherisksyoutakeeverysingleday,andwerecognizethatwiththeCOVID-19outbreaktheworldfeelsupsidedown.Youareshiftingyourofficesettingtotelehealth,learningnewtechnologies,determiningwhoneedsafacetofaceappointmentandhowtodothatsafely,andwheretosendpeoplewhomaybeinmoredistress.Werecognizethatwithallthechangescomesincreasedstress.Wealsorecognizetheincreasedriskandburdenplaceduponyouandyourfamily.Ifyouarestillneedingtoseepeoplefacetofaceforsupportoftheirbehavioralhealthcondition,yourdutytoservecanputyouatincreasedriskofgettingsickandconflictswithyourownsafety.Thatisastressmostwillneverunderstand.Wethankyouforshowingupdayafterday,andforshiftingtoworkthroughtechnology,whiletherestofthecommunitymaynotunderstandallthenuancesofwhatyoudo.Wethankyouforyourbraveryanddedicationtoservingotherseveryday,andespeciallyduringthiscrisis.

Theintentionofthiskitistoprovideresourcestohelppreserveyourownresilienceandmentalhealth,aswellasthatofyourfamily.Additionally,ithighlightsareasyoucanmonitorforyourselfandyourpeersduringthiscrisis,inordertoseekhelpearlyincopingwiththeuniquestressyouexperience.Manyfront-linebehavioralhealthprovidersareexperiencingincreasedlevelsofdepression,anxiety,insomniaandstress.Youarenotaloneinthesefeelings,and there are resources to help you get through them.

Resources for Behavioral Health Workers

For Your Family

Nebraska DHHS Guidance & Resources

http://dhhs.ne.gov/Pages/Coronavirus.aspx

OnMarch26,2020,GovernorPeteRickettssignedExecutiveOrder20-10whichsuspendsseveralstatutesandtheirimplementingregulationsfromtheUniformCredentialingActrelatingtospecifichealthcareproviders,includingmentalhealthcareproviders.ForFAQsrelatedtoExecutiveOrder20-10goto:http://dhhs.ne.gov/OEHS%20Program%20Documents/EMS%20EO%2020-10%20FAQ.pdf.

“Helping People Living Better Lives” | pg. 4

6

Childcare for Essential Workers in Nebraska

GovernorPeteRickettssignedExecutiveOrder20-08onMarch26,2020waivingcertainrequirementsregardingtheChildCareLicensingAct.TheDepartmentisaskingprogramstoserveasmanychildrenofessentialpersonnelascanbedonesafelyandappropriately,complyingwithallrequirementsoutlinedintheexecutiveorder.

Find Access to Child Care

Respondingtotheneedsofbehavioralhealthcareprovidersandotheressentialworkers,agroupofearlychildhoodstakeholdershascollaboratedtocreatetheNebraskaChildCareReferralNetwork—asearchabledatabaseatwww.NEchildcarereferral.org.

Thewebsiteallowsparentstosearchforchildcareprovidersby:

● address(includingmultipleradiusoptionsaroundyourhome)orzipcode● ageofchild(ren)● providerswhoacceptsubsidypayments● providerswhoarepartofStepUptoQuality

AllprogramslistedonthewebsitehavebeenlicensedbytheNebraskaDepartmentofHealthandHumanServicestocareforandeducateyoungchildrenandmeetsafetyandqualitystandardsoftheStateofNebraska.Providerswillbeencouragedtoupdatetheirinformationastheyfillopeningsorhaveslotsopenup,tokeepthedatabaseascurrent as possible.

ParentswhowouldlikemoreinformationabouthowtochooseaprovidercancallNebraska’sChildCareResourceandReferralLineat1-800-892-4453or402-557-6880.

For Your Health

EAP (Employee Assistance Programs)

AskyouremployerifyouhaveanEAPforfree,confidentialassessmentsandshort-termcounselingformentalandemotionalwell-being.ManyEAPshelpwithtraumaandotheremergencyresponsesituational.

Finding Better Sleep During COVID-19

https://www.cstsonline.org/assets/media/documents/CSTS_FS_Fight_COVID19_w_Better_Sleep_Health.pdf

Compassion Fatigue Resources

http://champsonline.org/assets/files/ToolsProducts/OEResources/CF-Resources-Handout.pdf

https://www.goodtherapy.org/for-professionals/business-management/human-resources/article/cost-of-caring-10-ways-to-prevent-compassion-fatigue

CSTS (Center for Study of Traumatic Stress) - Provider, Leader and Family Resources

https://www.cstsonline.org/resources/resource-master-list/coronavirus-and-emerging-infectious-disease-outbreaks-response

“Helping People Living Better Lives” | pg. 4

7

NAMI (National Alliance on Mental Illness)

https://www.nami.org/Find-Support

The American Psychological Association

https://www.apa.org/topics/stress/

American Psychiatric Association:

http://workplacementalhealth.org/Employer-Resources/Working-Remotely-During-COVID-19

https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2020/02/coronavirus-and-mental-health-taking-care-of-ourselves-during-infectious-disease-outbreaks

Nebraska DHHS Guidance & Resources

http://dhhs.ne.gov/Pages/Coronavirus.aspx

First – Be safe!

Thebestwaytopreventthespreadofillnessistostay home when you are sick.Behavioralhealthprovidershaveshiftedsomuchtotechnology,butevendoingthatworkandemotionallysupportingotherscanbeexhausting.Ifyouarestillengagedinfacetofaceencounters,youmayhavedirectcontactwithsickandotherwisevulnerablepopulations.Screeningstaffwhentheyreportfordutyreducestherisktopatientsandotheremployees.

Every healthcare worker, including behavioral health workers, like those in community mental health clinics, opioid treatment programs, and inpatient psychiatric units, should screen themselves every shift.

Answerthreesimplequestionswhenyoureportforduty:

Doyouhaveacough? Doyouhaveafever? Areyoushortofbreath?

Ifyouareexperiencingsymptoms,feelill,ordevelopafever–stayhomeandcontactyouremployerforfurtherdirectionregardingpotentialtesting,isolationandshiftcoverage,inaccordancewiththeirCOVID-19Plan.

Have a Plan in Case You Become Ill

At work:DiscusswhatwillhappenifyoubecomeillwithCOVID-19withyourmanagerorsupervisor.

● Wherewillyouisolate?● Howwillyouisolatefromyourfamilytoprotectthem?● Howwillyoubecompensatedduringisolation?● Howlongwillyouremployerexpectyoutoremainoffduty?Whatisthepolicyforreturningtowork?● Aretheretasksyoucandofromhomeifyoumustisolate?

“Helping People Living Better Lives” | pg. 4

8

At home:Findwaystogetyourfamilyinvolvedinroutineandemergencyactivitiesthatpreventthespreadofillnessin your home.

Prevent illness in your household:

● Washyourhandswithsoapandwater,especiallywhenreturninghomefromwork.● Cleanfrequentlytouchedsurfaceslikedoorknobs,counters,phones.● Teachyourfamilybestpracticesforhandwashing,coughandsneezehygiene,andsurfacecleaning.

PlanforillnessinthehouseholdBehavioralhealthworkershaveuniqueneedswhenitcomestoplanningforillnessinthehousehold.Discusswithyourfamilywhattodoifyoubecomeill,orifanotherfamilymemberbecomesill.Byparticipatingintheplan,yourfamilymightnotfeelasoverwhelmedorasiftheydonothavepowerinthesituation.

● Considerseparatelivingspacesandbathrooms.● Createaplanforchildcareandpetcareifyoubecomeill.● Createafamilyplanforwhereyouwillisolate(athomeorawayfromhome)ifyoubecomeill.● Discussthepossibilityforincreasedshifts,longershifts,schedulechanges,increasedtravel,ortelework

during this crisis.

Recognize When You Need A Break

ThefactthatCOVID-19ishuman-to-humantransmissible,relativelyunknown,andpotentiallyfatalmayintensifythefeelingsofpersonaldanger.Itisimportanttounderstandtypesofstresssothatyoucanrecognizetheminyourselfand in others.

Burnoutdescribesahumanresponsetochronicemotionalandinterpersonalstressatworksignaledbyexhaustion,cynicism,andworkinefficacy.

Compassionfatigueistheresultingexhaustionfromconstantexposuretothesamestressorleadingtodecreasedcompassion or empathy for others.

Resilienceistheabilitytoadaptsuccessfullyinthefaceoftrauma,adversity,tragedyorsignificantthreat.Creatingastressresilienceplanhelpsyoufightagainstburnoutandcompassionfatigue.

Create a Stress Resilience Plan

1Self-Assess

● Whataremyearlywarningsignsofexcessivestress?● WhatdoIdocurrentlyonadailybasisforself-care?● WhatdoIdoonaweeklybasistoimproveself-care?● WhatdoIdowhenmystresslevelisunusuallyhigh?

2Plan for

the Future

● WhatcanIaddtomyself-careroutine?● HowwillImaketimeforthesenewstrategies?● HowoftenshouldIreviewwhatIamdoing?● WhatchallengesdoIexpecttohavewithmyplanforchange?● HowwillIknowifmychangesarehelping?

3Get Support

● WhocanIturntoforsupportwithmyplan?● HowoftenshouldIcheckinwiththem?● WhatprofessionalsupportisavailableformeifIneedit?

“Helping People Living Better Lives” | pg. 4

9

Stay Healthy!

Behavioralhealthworkers,justlikeallthoseinhealthcare,needtotakecareoftheirownhealthtobeabletoprovidecareforindividualsinahigh-stressenvironment.Workersmustbeabletostayfocusedonthejobinthedynamic,crisisenvironment.

Pace Yourself

● Paceyourself,thispandemicisamarathon,notasprint.● Watchoutforeachother.Coworkersmaybeintentlyfocusedonaparticulartaskandnottakeappropriate

precautions to protect themselves.● Beconsciousofthosearoundyou.Youmightbeexhausted,stressed,oreventemporarilydistracted,and that can lead to errors or irritability.● Takefrequentrestbreaks.Mentalfatigue,particularlyoverlongshifts,cangreatlyincreaseworkers’riskof

injuryandburnout.

Prioritize Your Physical Health

● Keepingahealthyroutine,especiallyduringuncertaintimes,willhelpcurbstress.● Drinkplentyoffluids,especiallywater.● Maintainahealthydietandexercisewhenyouareable.Simplytaking20minutesandgoingforawalk can help manage stress.● Takebreaksawayfromyourworkspace,orgooutforfreshair,whenpossible.

Don’t Ignore Your Mental Health

Asabehavioralhealthworkers,youknowhowimportantmentalhealthis,butoftenforgettowatchyourownmentalhealth.Makesureyouthinkaboutyourmentalwell-beingduringthisextraordinarytimeofstress.Someofthefollowing may help:

● Keepintouchwithfriendsandfamily:Asimplephonecall,textmessage,orvideochathelpstomanagestressandkeepsyouincontactwiththosecloseandimportanttoyou.

● Limitmediaexposure:Takesometimeeverydaytodigitallyunplugandgetabreakfromallthemedia.● Recognizeandacceptwhatyoucannotchangesuchastheorganizationalstructure,complexwork

environment,waitingtimes,supplyshortages,etc.● Talktopeoplewhenyoufeellikeit.Youdecidewhenyouwanttodiscussyourexperience● Identifyabuddy,ideallyapeer,whounderstandsyouruniquestresses,andcheckinoftenwithoneanother.

Trytoprocessthedifficultiesofashiftoradayintheclinic,andthenpointoutpositiveelementstoo.Liftoneanotherup!

● Giveyourselfpermissiontofeelupsetorscared:youareinadifficultsituation.

● Recurringthoughts,dreams,orflashbacksarenormal—donottrytofightthem.But,remember,ifyoursleepissodisruptedthatitishardtofunction,taketimeoffandseekmental help. You cannot emotionally support othersaswellifyouarehavingdifficultiesandnot maintaining your own balance.

“Helping People Living Better Lives” | pg. 4

10

Identifying Stress

Physical

BehavioralhealthworkersexperiencinganyofthefollowingsymptomsshouldseekIMMEDIATEmedicalattention:

● Chestpain● Difficultybreathing● Severepain● Symptomsofshock

Ifbehavioralhealthworkersexperiencesymptomsovertimeoriftheybecomesevere,workersshouldseekmedical attention.

● Fatigue● Nausea/vomiting● Dizziness● Profusesweating● Thirst● Headaches● Visualdifficulties● Clenchingofjaw● Nonspecificachesandpains

Cognitive

Ifthesesymptomsoccuronthescene,workersmaynot be able to stay clearly focused to maintain their own safety or to help patients in distress.

Behavioralhealthworkersmayexperiencemomentarycognitivesymptoms;however,ifsymptomsarechronicorinterferewithdailyactivities,workersshouldseekmedical attention.

Thesesymptomsinclude:

● Confusion● Disorientation● Heightenedorloweredalertness● Poorconcentration● Poorproblemsolving● Difficultyidentifyingfamiliarobjectsorpeople● Memoryproblems● Nightmares

Behavioral

Asaresultofatraumaticincident,behavioralhealthworkersmaynoticethefollowingbehavioralchangesinthemselvesorcoworkers:

● Intenseanger● Withdrawal● Emotionaloutburst● Temporarylossorincreaseofappetite● Excessivealcoholconsumption● Inabilitytorest,pacing● Changeinsexualfunctioning

Emotional

Strongemotionsareordinaryreactionstoatraumaticorextraordinarysituation.Behavioralhealthworkersshouldseekmentalhealthsupportfromadisastermental health professional if distress continues for severalweeksoriftheyinterferewithdailyactivities.

Emotionalsymptomsinclude:

● Anxietyorseverepanic(rare)● Guilt/senseoffailure● Denial● Grief● Fear● Irritability● Lossofemotionalcontrol● Depression● Feelingoverwhelmed● Blamingothersorself

“Helping People Living Better Lives” | pg. 4

1 1

Managing Stress

Recognizing stress in yourself is important. Here are some things you can do for yourself to help you manage your stress:

Talk to your peersaboutthestressesoftheday,jobs,andotherworriesyoushare.Placeanemphasisonvalidatingone-another’sconcernswithoutfocusingonthegrim.Helppointoutpositiveelementsoftheshiftordayfor one another.

Seek help from support systemsavailableinthehealthcareenvironment.Manysystemshavepointpeopleorresourcestohelpwithburnout,fatigueandotherconcerns.Havingconversationsaboutyourworriescanhelpreduceanxiety.Checkoutthelistofresourcesattheendofthisdocumentaswell.

Self-care helps you stay stronginordertobetterhelpothers.Self-carecanbeeatinghealthy,exercisingandgettinggoodsleep.Self-caremayalsoincludetakingcareoffamily,includingchildrenandothers.Makingsureyoufillyourowncupisjustasimportantaspouringfromittoserveothers.

Stay in touch with older parents and family membersyouwouldnormallyvisit.Connectbyphoneorvideochat,writeletters,orsendsuppliessafelytotheirresidencetomaintainyourconnectedness.

Take things one day at a time-stepbackfromthe“sprint”mentality.Rememberthatthispandemicwillnotbesolvedquickly,treatitlikeamarathon.

Take mindful minutes.Slowbreathsonthetopofthehour,takingtimetorecognizeallthesmallthingsaroundyou,acknowledgingthem,andlettingthemgo.Gettingoutsideorsteppingawayfromyourworkspaceregularly.

r(888) 866-8660Information adapted from Michigan Department of Health and Human Services (2020, April 2). Supporting Emotional Healthof the Behavioral Health Workforce During COVID-19:https://www.michigan.gov/documents/coronavirus/Behavioral_Health_Workers_Final_685877_7.pdf