ECHO COVID-19 Emotional Health during Coronavirus and Community Unrest - Tools for Providers, Families, and Patients
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ECHO COVID-19
Emotional Health during Coronavirus and
Community Unrest
Tools for Providers, Families, and Patients
CRYSTAL ARMSTRONG, MD; TERESA LOPEZ, LCSW; MOLLY MCFADDEN, LCSW, MBA;
DANIELLE VALDEZ, LCSW
Advanced/Leadership
Objectives:
• Common Challenges emerging as a result of the
pandemic, community violence
• What we've learned from other mass casualty events
• Anxiety, Depression & Trauma responses
• Integrated Behavioral Medicine & Coping Skills to
address these challenges
• Taking care of ourselves and our community going
forward.
Advanced/Leadership
It is our responsibility as healthcare leaders, medical
providers, clinicians, and allied health professionals to be
informed about the effects the pandemic and
community unrest has on our mind & body.
COVID-19 & the Mental Health Pandemic
Advanced/Leadership
Mental Health during COVID-19:
• In March 2020, Pew Research Center assessed reported signs
of distress related to COVID-19 in the United States (n=1062):
• 80% of respondent reported high to moderate distress
• 60% reported feeling anxious or depressed in the last week
• 1 out of 4 reported binge drinking at least once in the last
week
• 1 out of 5 reported taking prescription drugs for non-
medical reasons
COVID-19 & HEALTH DISPARITIES: LONG-STANDING SYSTEMS
OF OPPRESSION AND BIAS
• More likely to develop
COVID-19 (SDOH)
• Black people with COVID-19
are diagnosed later in the
disease course
• Higher rates of
hospitalization, mechanical
ventilation, and death.
• Racism is one of the reasons
these disparities exist
https://www.samhsa.gov/sites/default/files/covid19-behavioral-health-disparities-black-latino-communities.pdf 6
CONFIDENTIAL
Advanced/Leadership
Racism, Discrimination, Xenophobia &
Community Unrest
"The fear & uncertainty
everyone is feeling due to
COVID-19 right now...is what
blacks, Latinos, Asian-
Americans feel ALL THE TIME
DUE TO RACISM"
- Vanessa Williams, Washington Post
Advanced/Leadership
COVID-19 & High Risk for Mental Illness
Financial/Occupational Risk: Older Adults:
Those who have lost their job or fear • Financial Security
losing their job are at a higher risk of • Mental Health and Isolation
Mental Illness or Suicide attempts • Responders- older persons are not
just victims, they are also health
care workers, care-givers, and
essential service providers
• Life & Death- 66% of people age
70 and over have at least one
underlying health condition
• Abuse & Neglect- in 2017, 1 in 6
older adults were subjected to
abuse. This violence is expected
to rise with lockdowns
Advanced/Leadership
COVID-19 & Substance Use
Substance Abuse:
• In April 2020, Utah has seen
an increase in ED admissions
for lethal and non-lethal
overdose deaths
• March 2020, Pennsylvania
county coroner’s office
saw confirmed and suspected
opioid deaths tripled
compared to January 2020
Advanced/Leadership
COVID-19 & Intimate Partner Violence
IPV Trends Utah: Domestic Violence Screening:
1.Are you ever afraid of your partner?
• 318 domestic violence cases that YES NO
Salt Lake County prosecutors
2.In the last year, has your partner hit,
received in the four weeks starting
kicked, punched or otherwise hurt you?
March 16 YES NO
3.In the last year, has your partner put
• 21% increase in cases compared
you down, humiliated you or tried to
with the same period a year ago control what you can do? YES NO
4.In the last year, has your partner
• West Valley City police department
threatened to hurt you? YES NO
stated there has reported a 28%
jump in domestic violence calls this
March compared with last yearAdvanced/Leadership
WHO Guidelines for working with
High Risk Populations:
1. Do not attach the disease to any particular ethnicity or nationality. Be
empathetic to all those who are affected, communicate safety &
compassion.
2. It is important to separate a person from having an identity defined by
COVID-19, in order to reduce stigma. Use these terms to refer people
who have COVID-19, “people who are being treated for COVID-19”,
or “people who are recovering from COVID-19."
3. Stay informed, but not saturated. Get the facts from reliable sources;
communicating facts can minimize fears with people affected. Gather
information at regular intervals.
4. Amplify positive and hopeful stories of people who have recovered.
https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_10Common Challenges
WHAT IS HAPPENING IN OUR MEDICAL COMMUNITY?
• Mark Mulcaire Jones, an IHC
Hospitalist who contracted
Covid-19 from a patient
• Here, Mark is in his garage,
roped off, surrounded by
chlorox wipes with a mask /
goggles / gloves and of course,
Corona beers and "Homemade
plaquenil—CHEAP"
CONFIDENTIALAdvanced/Leadership
Common Provider Fears:
• Healthcare workers over age 65 or
immuno-compromised have a greater fear of
contracting COVID-19 and dying
• We fear contaminating our patients, coworkers, and especially
our families
• We fear re-deployment to an area we do not regularly work in
• We fear being quarantined and unable to help our coworkers
• We fear occupational or financial loss
• We fear the unknown and have uncertainty for our futureSURPRISING STRESSORS TO OUR HEALTHCARE SYSTEM
• Quickly changing guidelines
• Virtual visit systems (most have tried more than one) and
the ethics of bringing patients in our clinics
• Ethics and supply concerns for PPE, who uses it (staff or
patients) and how do we protect those most at risk
• Re-deployment & hiring freezes can cause staffing
problems
• Significant non-covid illness due to patients skipping or
refusing needed medical care
• Countering mis-information
15
CONFIDENTIALAdvanced/Leadership
New Pandemic Challenges:
• Physical Distancing: 6' • Concurrent stressors of
• Disrupted home life and racism and natural
routine: work and school disasters
both at home • Loss of usual self-care
• Special events activities: exercise
cancelled: graduations • Stress of guiding our
• Influx of information, true loved ones and children
and false through these changes
and their fears
• Change fatigueAdvanced/Leadership These stressors = serious risk for Healthcare Workers The AMA has warned, “Physicians and other frontline healthcare professionals are particularly vulnerable to negative mental health effects as they strive to balance the duty of caring for patients with concerns about their own well-being, and that of their family and friends.” (AMA, 2020)
Advanced/Leadership
Healthcare
Professional Impacts:
workplace Stressed, unsupported • Negative impact on
Stress Cycle
staff
patient care
• Insecurities within
healthcare team
• Increased chance for
making other mistakes
• Decreased ability to care
Stressed institution & Low morale, high for and communicate
leadership turnover
with family post-event
Personal Impacts:
• Post-traumatic stress
• Anger
• Shame
• Insomnia
• Nervousness
• Effect on family life
Dissatisfied (possibly Poor patient care, • Depression
injured/traumatized) unsafe care
customers, staff environment • Increased Risk for SuicideAdvanced/Leadership
First Victims and Second Victims of COVID-19:
Healthcare Workers
• Even before the pandemic emerged, moral injury and burnout were rampant among
clinicians. Coping with Covid-19 has magnified many of those challenges and added new
ones with the reality of resource constraints.
• Our Trauma Exposure Responses: (Lipsky & Burk, 2009)
1. Feeling Helpless and Hopeless
2. A Sense that one can never do enough
3. Hypervigilance
4. Diminished creativity
5. Inability to embrace creativity
6. Minimizing “occurs when we trivialize a current situation by comparing it with another situation that we
regard as more dire”
7. Chronic exhaustion/Physical Ailments
8. Inability to Listen/Deliberate Avoidance
9. Dissociative Moments
10. Sense of persecution: “feeling a profound lack of efficacy in one’s life”
11. Guilt, Fear
12. Anger, cynicism
13. Inability to Empathize/Numbing
14. Addiction
15. Grandiosity” inflated sense of importance related to one’s workAdvanced/Leadership
Healthcare workers are already at
High Risk for Mental Illness & Suicide:
• Physicians/APC’s: One physician
completes suicide every day in the United
States.
• EMS Workers: First responders are more
likely to die from suicide than in the line of
duty.
• Nurses & Healthcare Workers: One recent
study on depression documented 18-40%
of nurses were moderate-severely
depressed.Advanced/Leadership
Covid -19 has already led to suicide in covid-
19 caregivers
• Lorna Breen, ER doc in NY completed suicide 4/27/20
• 2 days prior, a NY Bronx paramedic, John Mondello, also
completed suicide
https://nypost.com/2020/04/27/manhattan-er-doc-lorna-breen-commits-suicide-shaken-by-coronavirus/
• Daniela Trezzi, a 34 yo Italian nurse, completed
suicide due to fears she had spread Covid to others
(https://www.foxnews.com/world/italian-nurse-suicide-fears-spreading-coronavirus)
*The risk is real; this is why we NEED to increase our own ResilienceSTRATEGIES FOR MEDICAL PROVIDERS
1. Feel & Express your Feelings
2. Develop Social/Peer Supports
3. Incorporate Relaxation
strategies
4. Eating well
5. Practice sleep hygiene
6. Maintain a regular schedule
7. Keep a journal
8. Exercise
9. Maintain a sense of humor
22
https://postgraduateeducation.hms.harvard.edu/thought-leadership/strengthening-resiliency-health-care-providers-during-covid-19-
pandemic
CONFIDENTIALResiliency Strategies: Learning from other Mass Casualty Events
Advanced/Leadership
Findings from 9/11 & Ebola
9/11- (Smith et al. 2019; Brackbill, et al, 2009) Ebola- (Schrieber, et al, 2019)
• Qualitative study 54 EMTs •Pre-deployment plan/self-triage:
1. Anticipate stressors,
• Physical & social support
2. Strategies for distress tolerance,
• Longitudinal study rescue & 3. Identify 1 peer to consult with
recovery workers
•Found that it allowed people
• PTSD prevalence to identify stress
increased significantly over events. All included in study fell
the first six years post-9/11 below the threshold for PTSD
• Sleep & PTSD (Dietch et al. 2019) •Outbreak in Sierra Leone:
•Training & workshops
improved knowledge/skills improved
coping and mood during the outbreakAdvanced/Leadership
Learning from SARS and WHO Recommendations
SARS- (Chan et al, 2004) Caring for Children
• 177 health care participants 1. Practice 3 R's:
in Singapore • Reassurance,
• Psychosocial support more effective in • Routines
context of Pre-existing Relationships • Regulation
• Toronto Hospital Workers (Maunder,
2004) 2. Positive ways of coping; professional
• 29-35% with distress help if trauma remains unresolved
• Commonalities: 3. Understand reactions may vary
• Working in nursing • Seeking more attachment
• Working directly with SARS patients
• Having young children at home 4. Emphasize strengths, hope, positivity
to help them feel secure & safe
5. Social connectiveness while
physical distancing
6. Age-appropriate information (stories,
books)Advanced/Leadership
Health Care Worker Resiliency Research
1. "One size fits all" in ineffective
2. Psychological First Aid (Nat. Center for PTSD)
3. EMS: Pre-deployment Plan (Anticipate/Plan/Deter)
a) Sleep hygiene, deep breathing, relaxation, visualization
b) Stress inoculation & self-triage instrument (temperature daily)
4. Folkman & Greer's (2000) EBP Model
a) Problem Solving events appraised to be within one's control
b) Emotion-based coping to enhance support & reduce isolation
c) Meaning-based coping for unresolved events & cause persistent distress
5. Organizational Support (SARS)
• Decentralized decision-making, flexible scheduling, investment in
continuing education and unit-level self-government
https://www.who.int/docs/default-source/coronaviruse/mental-health-
considerations.pdf?sfvrsn=6d3578af_10http://file.lacounty.gov/SDSInter/dhs/220927_AnticipatePlanDeterInstructorPP-FINAL110414.pdf 27
CONFIDENTIALAnxiety, Depression & Trauma
Advanced/Leadership
Stress vs. Anxiety
• Fear is a
normal and
adaptive
response to
a perceived
threatAdvanced/Leadership
Fight-Flight-Freeze Response:
Fight-or-flight response The “Window of Tolerance”
When you feel threatened, your nervous The “Window of Tolerance” (Ogden, et al.
system responds by releasing a flood of stress (2006); Siegel, 1999) is
hormones, including adrenaline and cortisol,
which rouse the body for emergency "the optimal zone of arousal where we
action. are able to manage and thrive in
everyday life".
• Heart pounds faster,
• Muscles tighten, When we are outside of our window of
• Blood pressure rises, tolerance, our nervous system responds by
• Breath quickens, going into survival mode – fight, flight or
• Senses become sharper. freeze.
• Strength and stamina increases
• Improved reaction time,
• Focus is enhanced—preparing you to
either fight or flee from the danger at
hand.Advanced/Leadership Neuroscience of Trauma Response: Underlying principle: There are two separate pathways in the brain that can give rise to anxiety(Ochsner, Ray, Hughes, McRae, Cooper, Weber,Gabrieli, & Gross, 2009) • Bottom Up Triggering of Emotion Links between perceptual representations and amygdala • Top Down Emotion Generation (e.g., cortex processes) Links between high-level cognitive representations of stimulus meanings and amygdala
Advanced/Leadership Brain Plasticity:
Integrated Behavioral
Medicine:
Biopsychosocial Distress Tolerance & CopingAdvanced/Leadership
Advanced/Leadership
Nutritional Psychiatry:
Pre & Probiotics Research: Mood & Foods
• The risk of depression was 25-35% Improves MDD
lower in Mediterranean or • Leafy greens & Broccoli
Japanese diets, compared to
“Western diets” • Fish & Fish Oil
• Walnuts, almonds, hazelnuts
• 2015 Harvard Medical School on • Lentils, chickpeas, beans
Nutritional Psychiatry/Probiotics: Decreases Anxiety
• an improved mental outlook,
• a decreased perception of • Dark Chocolate & Cacao
stress Improves cognitive functioning
• decreased anxiety levels • Berries, BlueberriesAdvanced/Leadership
Hydration:
• Dehydration Saps Your Brain’s
Energy
• Dehydration impedes your brain’s
serotonin production
• Dehydration increases stress in your
body.
• Panic attacks are common results of
high anxiety caused by
dehydration. Panic attacks typically
have physical triggers, and one of
those triggers is dehydration.Advanced/Leadership
Sleep & Healthcare Workers:
• Studies have shown that short sleep duration is common among
nurses and healthcare workers. (Luckhaupt et al. 2010)
• Insufficient sleep in healthcare workers might have adverse effects
on the quality of healthcare. A cross-national investigation in six
countries found high level of nurses’ burnout was associated with
lower rating of quality of care. (Poghosyan et al. 2010)
• Sleep is essential for life and our mental health, lowering the rates of
burnout.
• Acute & Chronic Insomnia- 30 minutes of difficultiesAdvanced/Leadership
Sleep & Circadian Rhythm
Sleep deprivation increases activation in amygdala
REM sleep is particularly correlated with amygdala
reactivity. More REM sleep, less reactivity.
Circadian Health includes:
• Maintaining regular sleep schedules,
• Avoiding going to bed thirsty
• Feeling worried whilst falling asleep
• Avoiding screen time 2 hours prior; blue light filters
• Light exposure 1st thing in morning
• Short naps (10-20 min.)
It is well-documented that sleep hygiene is associated with psychological wellbeing
(Pilcher et al., [48])Advanced/Leadership
Healing with Physical Health:
PHYSICAL ACTIVITY Health Benefits:
•Improved sleep
•Increased interest in sex
•Better endurance
•Stress relief
•Improvement in mood
•Increased energy and stamina
•Reduced tiredness that can increase mental
alertness
•Weight reduction
•Reduced cholesterol and
improved cardiovascular fitnessAdvanced/Leadership Health benefits from being in Nature: Being in/Connecting to nature shown to: •Increase health‐ immunity •Reduce depression and anxiety symptoms •Improve hypertension, cardiovascular illnesses, and increase vitality •Improve mental fatigue and increase attention capacity •Improve life satisfaction, happiness, meaningfulness, and MINDFULNESS •Contact (somatic), emotion, meaning, compassion and engagement with natural beauty helps people feel closer to nature‐ MINDFULNESS enhances this experience when we are in nature 5 minutes
Advanced/Leadership Mindfulness-Based Stress Reduction: MINDFULNESS RESEARCH • Immune System Functioning improves- sick less often • Stress levels (measured by cortisol) decrease • Compliance with medication, diet and other health recommendations improve • Improves brain functioning • ability make better decisions • inhibit automatic functions • decreases size of the amygdala- helping nervous system to operate functionally • Decreases stress, anxiety and depression
Advanced/Leadership Cognitive-Behavioral Strategies: • Tuning into your senses (relaxing the • Self-Concept/Future Orientation body, clearing the mind clutter) • Positive Psychology • What are my storylines • Narrative Therapy • Thought labeling • Exposure Therapy • Awareness of “Mind Clutter” and “Body • EMDR (complex trauma) Tension” • Awareness of unmet expectations • Experiencing your Source (wellspring of inner wisdom)
Advanced/Leadership
Psychosocial Strategies for long-term
maintenance:
• Boundaries: stamina, physical, psych
• Trauma Affirmation • Expression of Grief for lost
• Introduction to the observing self, identification, self/life/identity
and differentiation • Clarification of values/norm
• Education about ego loss and dissociation development
• New and Integrated Identity development • Spiritual/philosophical experience
• Assertion of positive values, humor • Continued meaning development
• Establishment of individualized psychological • Creative processes
behavioral/structural goals • New learning
• Relapse Prevention • Engagement in social or political actionAdvanced/Leadership RELAXATION RESPONSE ACTIVATION
Technique Concept
Breath Awareness Shift from shallow breathing to abdominal breathing
Self-Hypnosis Narrow consciousness without completely losing awareness, to allow suspension of
disbelief and experience of thoughts & images as real
Autogenic Training Use verbal commands that suggest bodily warmth and heaviness in the limbs
Progressive Muscle Relaxation Alternately tense and relax different muscle groups, to better distinguish between the two
states.
Transcendental Meditation Engage in attempting to anchor attention to the moment nonjudgmentally as they enter
awareness
Mindful Awareness Observation or attention to phenomena in the moment, nonjudgmentally, as they enter
awareness.
Yoga Movement meditation correlated with the breath.Community Physician’s Group
Primary Care
Psychological First Aid Surge PlanCPG PSYCHOLOGICAL FIRST AID PLAN
Primary Care Departments:
Focus Area: PCP Urgent Care Nursing Staff Social Work
Mental Wellness and Resiliency resources for staff and families
General
https://healthcare.utah.edu/wellness/resiliency-center/coronavirus-wellbeing-resources.php
Weekly stress Monthly
Resiliency
Weekly Stress management COVID-19
Education & Resiliency Center in-services & debriefs: Center in-
Management practice at mind/body
Debriefs Megan Call services &
practice Monday practice in-
debriefs
meetings. service
Weekly clinical team debriefs
Weekly clinical debriefs with Medical Daily clinical huddles, weekly
Clinical Meetings with Clinic or nursing
Directors strategy meetings
leadership
Yammer (U Health Peer mentor charter:
Peer Support Yammer Platform Monthly Peer Supervision
Platform In development)
Weekly & Monthly questions
Weekly Outreach Outreach at 1:1 supervision:
Questions: questions Outreach questions
Individualized questions/feedback
recommende recommended to nursing &
Outreach
d to UC clinic leadership
1. Work- 2. General leadership 1. Work- 2. Self-Care
Related Support Related questions?
Appendix Resources & References
RESOURCES FOR MEDICAL PROVIDERS & FAMILIES
• Resources for Leadership
• Communicating With Caring - how to talk to team members, volunteers, patients (Planetree International)
• Mentoring During the COVID Pandemic (Nature)
• Webinars/Podcasts/Courses
• University of Washington Faculty Resources
• University of Washington Recorded Webinar: Coping With Uncertainty About The Coronavirus
(You must register and then will receive immediate access to the webinar.)
• Yale’s Science of Well-Being Course on Coursera, free enrollment starts March 30
• Caring for Ourselves in Times of Crisis a webinar from The Beryl Institute
•
• Mindfulness/Meditation/Self-Care
• Healthy Minds App , free to individuals
• Ten Percent Happier App , free to healthcare workers for COVID for 6 months
• Headspace Plus App , free to healthcare professionals
• Insight Timer App , free app for sleep, anxiety, and stress
• Daily Social Distancing Tapping Support Sessions on Zoom , no registration needed (courtesy of Jill Wener, MD), every M-F at 12pm ET at. Or you can watch
the repost on YouTube .
49
CONFIDENTIALRESOURCES FOR MEDICAL PROVIDERS & FAMILIES
• 7-Day Coronavirus Emotional Survival Kit for Healthcare Professionals : free but must sign up
• Daily online compassion practice and fellowship , offered by the Emory Center for Compassion and led by Emory-Certified CBCT®teachers, daily at 9am and
7pm ET
• How to Tame Your Wandering Mind , a TED Talk by Amishi Jha
• Taking Care of Yourself During COVID-19 Uncertainty (Med+Ed)
• 8 apps to support your mental health during the coronavirus pandemic (Good Morning America)
• 5-minute guided grounding meditation exercise (VA Health)
•
• Arts and Well-Being
• Mindfulness and art with Google’s Arts & Culture collections (Google Arts & Culture features content from over 2000 leading museums and archives who
have partnered with the Google Cultural Institute to bring the world's treasures online.)
• NY Phil Plays On - free on-demand concerts (New York Philharmonic)
• Paris Opera - free archived shows
• New York Metropolitan Opera - free nightly live streams at 7:30 pm ET
• London's National Theatre - free full-length plays every Thursday
•
• Fitness
• Peloton App 90-Day Free Trial (no credit card required when signing up through the app)
• Fitness Blender , free workout videos for all levels
• CorePower Yoga On-Demand Classes , free
50
CONFIDENTIALRESOURCES FOR MEDICAL PROVIDERS & FAMILIES
• Pre-shift Yoga for Healthcare Providers on YouTube
• Emory School of Medicine Yoga, daily at 5:30-6:15 (ET), all are welcome:
• Daily, 5:30-6:15pm (ET)
• Starting March 28, 2020, every other Saturday, 10-11am (ET), Instructor: Joe Palese
• Monday-Friday, 1pm-2pm (ET), Instructor: Joe Palese
• This Zoom link works for all classes:
https://zoom.us/j/587193971
Meeting ID: 587 193 971
• How Much Physical Activity Do You Need? Recommendations from the WHO
•
• Sleep
• Sleep Is Your Super Power , a TED Talk by Matthew Walker, PhD
• Ten Percent Happier Podcast, Episode #221, All of Your Sleep Questions Answered , with Matthew Walker, PhD
• Coronavirus: Social distancing may be a rare chance to get our sleep patterns closer to what nature intended (The Conversation)
• Sleep, sunlight and self-care: A psychiatrist’s advice for pandemic mental health (PBS)
•
• Blogs/Articles
• Coronavirus Disease 2019 (COVID-19) and Beyond: Micropractices for Burnout Prevention and Emotional Wellness (JACR)
• 11 Tips for Staying Calm During the Time of Coronavirus (Gretchen Rubin, author of The Happiness Project)
• I Spent a Year in Space, and I Have Tips on Isolation to Share (NY Times)
• That Discomfort You’re Feeling is Grief (Harvard Business Review)
• 6 Ways to Address Physician Stress During COVID-19 Pandemic (AMA)
• Coronavirus Anxiety - Helpful Expert Tips and Resources (Anxiety and Depression Association of America)
• Maintaining Mental Health During the Coronavirus Pandemic – Resources and Tools (University of Michigan)
51
CONFIDENTIALREFERENCES & EVIDENCE
• Dietch JR, Ruggero CJ, Schuler K, Taylor DJ, Luft BJ, Kotov R. Posttraumatic stress disorder symptoms and sleep in the daily lives of World Trade Center responders. J
Occup Health Psychol. 2019;24(6):689‐702. doi:10.1037/ocp0000158
• Bohlken J, Schömig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19-Pandemie: Belastungen des medizinischen Personals [COVID-19 Pandemic: Stress
Experience of Healthcare Workers - A Short Current Review]. Psychiatr Prax. 2020;47(4):190‐197. doi:10.1055/a-1159-5551
• Fennell, P.A. & Bateman, L. (2005). A Team Approach to Treating CFS. The CFS Research Review, (2)6-11.
• Fennell, P.A., Jason, L. A., Taylor, R. R., Fricano, G., Halpert, J., Klein, S.M., & Levine, S. (2001, January). An Examination of Phases in Chronic Fatigue Syndrome.
Proceedings of the AACFS Research Conference, Seattle, WA.
• Jason, L.A., Fricano, G., Taylor, R.R., Halpert, J., Fennell, P.A. (2000).Chronic Fatigue Syndrome: An Examination of the Phases. Journal of Clinical Psychology, 56,
1497-1508.
• Jason, L.A., Fennell, P.A., Taylor, R. R., Fricano, G., Halpert, J. (2000). An Empirical Verification of the Fennell Phases of the CFS Illness. Journal of Chronic Fatigue
Syndrome, 6(1), 47-56.
• Jason, L.A., Fennell, P.A. , Klein, S., Fricano, G., Halpert, J. (1999). An Investigation of the Different Phases of the CFS Illness. Journal of Chronic Fatigue Syndrome,
5(3/4), 35-53.
• Fennell, P.A., Jason, L.A., and Klein, S.M. (1999). Measuring Phases of Recovery in Patients with CFS. Journal of Chronic Fatigue Syndrome, 5(3/4), 88-89.
• ´Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T….Stevens, M. (2011). The national intimate partner and sexual violence survey: 2010
summary report. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved
from http://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf
• ´Center for Disease Control (2017). Intimate Partner Violence. Retrieved from https://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html.
• ´Miller, E., McCaw, B, Humphreys, B. L., & Mitchell, C. (2014). Integrating Intimate Partner Violence assessment and intervention into healthcare in the United States:
a systems approach. Journal of Women’s Health, 24: 92-99. DOI: 10.1089/jwh.2014.4870
• ´Queensland Government (1998). Domestic violence initiative screening tool, from http://www.health.qld.gov.au/violence/domestic/dvi/publications.asp)
Additional Reference: Webster J, Stratigos SM, Grimes KM (2001). Women’s responses to screening for domestic violence in a health-care setting. Midwifery, 17, 289-
294. Webster J, Holt, V. (2004). Screening for partner violence: direct questioning or self-report? Obstetrics & Gynecology, 103, 299-303.
52
CONFIDENTIALRESOURCES FOR MEDICAL PROVIDERS & FAMILIES
• How can I cope with redeployment? (BMJ)
• Burned out on Burnout? (The Health Care Blog)
• A psychologist’s science-based tips for emotional resilience during the coronavirus crisis (The Washington Post)
• Managing Mental Health During COVID-19 (AMA)
• “We Signed Up for This!” — Student and Trainee Responses to the Covid-19 Pandemic (NEJM)
• COVID-19 Resources for Healthcare Providers, Families, and Leadership (Med+Ed)
• Coronavirus: Why healthcare workers are at risk of moral injury (BBC)
• Anxiety is high because of coronavirus. Here’s how you can feel better. (Washington Post)
•
• Communicating With Children
• Helping Children Cope With Changes Resulting From COVID-19 (National Association of School Psychologists)
• How to Talk to Your Kids About Coronavirus (PBS)
• Just for Kids: A Comic Exploring the New Coronavirus (NPR)
• Coronavirus Coloring Book Designed to Help Children Cope With the Pandemic (St. Jude Children's Research Hospital)
• Sesame Street: Elmo's Playdate episode, designed to help explain social distancing
• "A Terrible Thing Happened" by Margaret Holmes
• "Earthquakes" by Ellen J. Prager
• "What is an Earthquake?" Video https://youtu.be/dJpIU1rSOFY
• "I Will Always Love You" by Melissa Lyons
• "The Rhino Who Swallowed a Storm" by LeVar Burton & Susan Schaefer Bernando
• https://www.anagomez.org/covid-19-resources/
53
CONFIDENTIALREFERENCES, CONT.
• Taylor, R.R. (2006). Cognitive behavioral therapy for chronic illness and disability. Springer Science & Business Media. http://books.google.com/books?id=LE7T5C-
cUkEC&lr=&source=gbs_navlinks_s
• Edwards, C.R., Thompson, A.R., Blair, A. (2007). An 'overwhelming illness' women's experiences of learning to live with chronic fatigue syndrome/myalgic
encephalomyelitis. Journal of Health Psychology, 12(2), 203-214. doi: 10.1177/1359105307071747
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