Applying behavioral science to workforce challenges in the public health emergency preparedness system

Authors

  • O. Lee McCabe, PhD
  • Carlo C. DiClemente, PhD
  • Jonathan M. Links, PhD

DOI:

https://doi.org/10.5055/ajdm.2012.0091

Keywords:

transtheoretical model, willingness to respond, willingness to train

Abstract

When disasters and other broad-scale public health emergencies occur in the United States, they often reveal flaws in the pre-event preparedness of those individuals and agencies charged with responsibility for emergency response and recovery activities. A significant contributor to this problem is the unwillingness of some public health workers to participate in the requisite planning, training, and response activities to ensure quality preparedness.
The thesis of this article is that there are numerous, empirically supported models of behavior change that hold potential for motivating role-appropriate behavior in public health professionals. The models that are highlighted here for consideration and prospective adaptation to the public health emergency preparedness system (PHEPS) are the Transtheoretical Model of Intentional Behavior Change (TTM) and Motivational Interviewing (MI). Core concepts in TTM and MI are described, and specific examples are offered to illustrate the relevance of the frameworks for understanding and ameliorating PHEPS-based workforce problems. Finally, the requisite steps are described to ensure the readiness of organizations to support the implementation of the ideas proposed.

Author Biographies

O. Lee McCabe, PhD

Department of Mental Health, Preparedness and Emergency Response Research Center, Preparedness and Emergency Response Learning Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.

Carlo C. DiClemente, PhD

Department of Psychology, UMBC, Catonsville, Maryland.

Jonathan M. Links, PhD

Department of Environmental Health Sciences, Preparedness and Emergency Response Research Center, Preparedness and Emergency Response Learning Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

References

Hsu EB, Thomas TL, Bass EB, et al.: Healthcare worker competencies for disaster training. BMC Med Educ. 2006; 20(6): 19.

Parker CL, Everly GS, Barnett DJ: Establishing evidence-informed core intervention competencies in psychological first aid for public health personnel. Int J Emerg Mental Health. 2006; 8(2): 83-92.

Kutcher S, Chehil S: Application of a needs-driven, competenciesbased mental health training program to a post-disaster situation: The Grenada experience. Am J Disaster Med. 2008; 3(4): 235-240.

PAHPA: Pandemic and All-Hazards Preparedness Act, Pub L No. 109-417, §101 et seq 2006.

Hodge JG Jr, Gostin LO, Vernick JS: The Pandemic and All- Hazards Preparedness Act: Improving public health emergency response. JAMA. 2007; 297(15): 1708-1711.

IOM: The Future of the Public’s Health in the 21st Century. Washington, DC: National Academies Press, 1988.

IOM:Who will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Washington, DC: National Academies Press, 2003.

IOM: Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report.Washington, DC: The National Academies Press, 2008.

McCabe OL, Barnett DJ, Taylor HG, et al.: Ready, willing, and able: A framework for improving the public health emergency preparedness system. Disaster Med Pub Health Prep. 2010; 4: 161-168.

Associated Press: New Orleans police fire 51 for desertion. Available at http://www.msnbc.msn.com/id/9855340/ns/us_newskatrina_the_long_road_back/t/new-orleans-police-fire-desertion/. Accessed May 10, 2012.

Ramalingaswami V: Psychological effects of the 1994 plague outbreak in Surat, India. Mil Med. 2001; 166: 29-30.

Qureshi K, Gershon RRM, Sherman MF, et al.: Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005; 82: 378-388.

DiMaggio C, Markenson D, Loo G, et al.: The willingness of U.S. emergency medical technicians to respond to terrorist incidents. Biosecur Bioterror. 2005; 3(4): 331-337.

Balicer RD, Omer SB, Barnett DJ, et al.: Local public health workers’ perceptions toward responding to an influenza pandemic. BMC Public Health. 2006; 6: 99.

Barnett DJ, Balicer RD,Thompson CB, et al.: Assessment of local public health workers’ willingness to respond to pandemic influenza through application of the Extended Parallel Process Model. PLoS One. 2009; 4: e6365.

Coleman CH, Reis A:Potential penalties for health care professionals who refuse to work during a pandemic.JAMA. 2008; 12: 1471-1473.

Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall, 1986.

Bandura A: Self-Efficacy: The Exercise of Control. New York: Freeman, 1997.

Barnett DJ, Everly GS, Parker CL, et al.: Applying educational gaming to public health workforce emergency preparedness. Am J Prev Med. 2005; 28: 390-395.

DiClemente CC, Prochaska JO: Toward a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. In Miller WR, Heather N (eds.): Treating Addictive Behaviors. 2nd ed. New York: Plenum, 1998.

Prochaska JO, DiClemente CC: The Transtheoretical Approach: Crossing the Traditional Boundaries of Therapy. Malabar, FL: Krieger Publishing Co, 1984.

Prochaska JO, DiClemente CC, Norcross JC: In search of how people change: Applications to addictive behaviors. Am Psychol. 1992; 47: 1102-1114.

Miller WR, Rollnick S: Motivational Interviewing: Preparing People for Change. 2nd ed. New York: Guilford Press, 2002.

DiClemente CC. Addiction and Change: How Addictions Develop and Addicted People Recover. New York: Guilford, 2003.

DiClemente CC: Conceptual models and applied research: The ongoing contribution of the transtheoretical model. J Addict Nurs. 2005; 16: 5-12.

Nigg CR, Burbank PM, Padula C, et al.: Stages of change across ten health risk behaviors for older adults. Gerontologist. 1999; 39(4): 473-482.

Kruszynski R, Boyle PE: Implementation of the integrated dual diagnosis treatment model: Stage-wise strategies for service providers. J Dual Diagn. 2006; 2(3): 147-155.

Phillips E, Madison N, Pomerantz SC, et al.: Identifying and assessing interests and concerns of priority populations for worksite programs to promote physical activity. Health Promot Pract. 2010; 11(1): 71-78.

DiClemente CC, Schlundt D, Gemell L: Readiness and stages of change in addiction treatment. Am J Addict. 2004; 13: 103-119.

Velasquez MM, Gaddy-Maurer GG, Crouch C, et al.: Group Treatment for Substance Abuse: A Stages of Change Therapy Manual. New York: Guilford Press, 2001.

DiClemente CC, Velasquez M: Motivational interviewing and the stages of change. In Miller WR, Rollnick S (eds.): Motivational Interviewing. 2nd ed. New York: Guilford, 2002.

Miller WR: Motivational enhancement therapy: Description of counseling approach. In Boren JJ, Onken LS, Carroll KM (eds.): Approaches to Drug Abuse Counseling. Bethesda, MD: National Institute on Drug Abuse, 2000.

Kemp R, Kirov G, Everitt B, et al.: Randomised controlled trial of compliance therapy: 18-Month follow-up. Br J Psychiatry. 1998; 172: 413-419.

Daley DC, Zuckoff A: Improving compliance with the initial outpatient session among discharged inpatient dual diagnosis clients. Soc Work. 1998; 43(5): 470-473.

Daley DC, Salloum IM, Zuckoff A, et al.: Increasing treatment adherence among outpatients with depression and cocaine dependence: A pilot study. Am J Psychiatry. 1998; 155: 1611-1613.

Swanson AJ, Pantalon MV, Cohen KR: Motivational interviewing and treatment adherence among psychiatric and dually-diagnosed patients. J Nerv Ment Dis. 1999; 187: 630-635.

Martino S, Carroll KM, O’Malley SS, et al.: Motivational interviewing with psychiatrically ill substance abusing patients. Am J Addict. 2000; 9: 88-91.

Stotts AL, DiClemente CC, Dolan-Mullen P: One-to-one: A motivational intervention for resistant pregnant smokers. Addict Behav. 2002; 27: 275-292.

Berg-Smith SM, Stevens VJ, Brown KM, et al.: A brief motivational intervention to improve dietary adherence in adolescents. Health Educ Res. 1999; 14(3): 399-410.

Colby SM, Monti PM, Barnett NP, et al.: Brief motivational interviewing in a hospital setting for adolescent smoking: A preliminary study. J Consult Clin Psychol. 1998; 66(3): 574-578.

Emmons KM, Rollnick S: Motivational interviewing in health care settings: Opportunities and limitations. Am J Prev Med. 2001; 20(1): 68-74.

Ershoff DH, Quinn VP, Boyd NR, et al.: The Kaiser Permanente prenatal smoking cessation trial: When more isn’t better, what is enough? Am J Prev Med. 1999; 17(3): 161-168.

Miller WR: Motivational interviewing: Research, practice, and puzzles. Addict Behav.1996; 21(6): 835-842.

Rakowski W, Dube CE, Marcus BH, et al.: Assessing elements of women’s decisions about mammography. Health Psychol. 1992; 11(2): 111-118.

Resnickow K, Jackson A,Wang T, et al.: A motivational interviewing intervention to increase fruit and vegetable intake through black churches: Results of the Eat for Life trial. Am J Public Health. 2001; 91: 1686-1693.

Taplin S, Barlow W, Ludman E, et al.: Testing reminder and motivational telephone calls to increase screening mammography: A randomized study. J Nat Cancer Inst. 2000; 92(3): 233- 242.

Velasquez MM, Hecht J, Quinn VP, et al.: Application of motivational interviewing to pre-natal smoking cessation: Training and implementation issues. Tobacco Control. 2000; 9(3): 36-40.

Carbonari JP, DiClemente CC: Using transtheoretical model profiles to differentiate levels of alcohol abstinence success. J Consult Clin Psychol. 2000; 68(5): 810-817.

DiClemente CC: Self-efficacy and the addictive behaviors [Special issue: Self-Efficacy Theory in Contemporary Psychology]. J Soc Clin Psychol. 1986; 4: 302-315.

DiClemente CC, Fairhurst SK, Piotrowski NA: Self-Efficacy, Adaptation, and Adjustment: Theory, Research, and Application. New York, NY: Plenum Press, 1995.

Gossop M, Green L, Phillips G, et al.: Factors predicting outcome among opiate addicts after treatment. Br J Clin Psychol. 1990; 29(2): 209-216.

Velicer WF, DiClemente CC, Rossi JS, et al.: Relapse situations and self-efficacy: An integrative model. Addict Behav. 1990; 15: 271- 283.

Miller WR, Rollnick S: Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press, 1991.

Miller WR, Zweben A, DiClemente CC: Motivational Enhancement Therapy Manual: A Clinical Research Guide for Treating Individuals with Alcohol Abuse and Dependence,Vol. 2.Washington, DC: National Institute on Alcohol Abuse and Alcoholism, 1995.

Steinberg ML, Ziedonis DM, Krejci JA, et al.: Motivational interviewing with personalized feedback: A brief intervention for motivating smokers with schizophrenia to seek treatment for tobacco dependence. J Consult Clin Psychol. 2004; 72: 723-728.

Dench S, Bennett G: The impact of brief motivational intervention at the start of an outpatient day programme for alcohol dependence. Behav Cogn Psychother. 2000; 28: 121-130.

Miller WR, Zweben A, DiClemente CC, et al.: Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism, 1992.

Project MATCH Research Group: Matching alcoholism treatments to client heterogeneity: Project MATCH post-treatment drinking outcomes. J Stud Alcohol. 1997; 58: 7-29.

Project MATCH Research Group: Project MATCH secondary a priori hypotheses. Addiction. 1997; 92: 1671-1698.

Miller WR, Benefield RG, Tonigan JS: Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. J Consult Clin Psychol. 1993; 61(3): 455-461.

Sellman JD, Sullivan PF, Dore GM, et al.: A randomized controlled trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence. J Stud Alcohol. 2001; 62: 389-396.

Perz CA, DiClemente CC, Carbonari JP: Doing the right thing at the right time? Interaction of stages and processes of change in successful smoking cessation. Health Psychol. 1997; 15: 462-468.

McCabe OL, Perry C, Azur M, et al.: Psychological first aid training for paraprofessionals: A systems-based model for enhancing capacity of rural emergency response. Prehosp Disast Med. 2011; 26(4): 1-8.

McCabe OL, Perry C, Azur M, et al.: Guided preparedness planning with lay communities: Enhancing capacity of rural emergency response through a systems-based partnership. Prehosp Disast Med. In press.

Anderson LW, Krathwohl DR: A Taxonomy for Learning, Teaching, and Assessing. New York: Longman Publishing, 2001.

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Published

04/01/2012

How to Cite

McCabe, PhD, O. L., C. C. DiClemente, PhD, and J. M. Links, PhD. “Applying Behavioral Science to Workforce Challenges in the Public Health Emergency Preparedness System”. American Journal of Disaster Medicine, vol. 7, no. 2, Apr. 2012, pp. 155-66, doi:10.5055/ajdm.2012.0091.

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