Rural and tribal communities are at substantial risk from COVID-19, the disease pandemic caused by SARS-CoV-2 (CNN, NYTimes, Vox). Several factors contribute to this risk, including a paucity of acute-care resources; long drive-times to access care; an aging population, often with complicating health issues; and multi-generational homes with a high proportion of essential workers (Politico).  Geographic isolation may delay the arrival of COVID-19 in rural areas, but that isolation is also associated with delays in essential responses, social distancing measures, testing for the virus followed by vigorous contact tracing, and addressing mental health issues that arise from uncertainty due to prolonged social distancing and isolation. Fear and anxiety about a disease, long-term uncertainty about employment, relationships in the homes, and family economy can be overwhelming and evoke strong emotions.

Vashon is a rural community of 11,000 on an island in Puget Sound, near Seattle, WA.  We have neither acute care nor hospital care. We have Mental Health Providers in practice on the island. During this pandemic, those providers may reach capacity. With that in mind, the Community Care Team, the volunteer counseling and behavioral health unit of Vashon Medical Reserve Corps, developed strategies that provide short-term mental health crisis intervention and spiritual support to meet the increasing demand for social emotional support in the community.

We believe that by following this grassroots, cost-effective blueprint, rural and tribal communities could set up a similar mental/spiritual health model using licensed Mental Health Providers and volunteer experienced Spiritual Care Providers.

The Community Care Team (CCT) is the volunteer counseling and behavioral health unit of Vashon Medical Reserve Corps (MRC), which is charged with responding to increased medical and mental health needs during or after a disaster or emergency. The CCT, under the MRC and VashonBePrepared, the island’s disaster preparedness coalition, was initiated to create additional capacity for crisis intake of mental health needs, assessments and triage, resource information, individual and family support, and disaster-related emotional assistance during a Federal- and State-declared emergency, in coordination with existing agency providers and VashonBePrepared.

Reactivation
The CCT, initially activated for disaster response, was reactivated for pandemic response in March 2020. MRC/VashonBePrepared hosted a Zoom videoconference to recruit mental health practitioners and spiritual care providers from the community. The team grew from 2 to 28 members through March and April 2020.

A Spiritual Health arm of CCT, the Spiritual Resources Group, was added to meet the spiritual needs in the community, with leaders from multiple faith traditions and spiritual practices. The term “spiritual” is intended in as broad a sense as possible.  It is not limited to and does not assume belief or religion.

COVID Response
We know that there will be an increased demand for mental health services as time goes on. State and national health organizations have predicted that the need will be greatest from October through December 2020, in terms of suicidality, depression, anxiety, and abuse. We are preparing for that eventuality. The CCT Help Line mental health practitioners are trained to assess mental health needs, triage, and refer to other agencies if needed. In addition to being state licensed professionals, our providers are given legal protection from malpractice lawsuits because we enroll them as Washington State Registered Emergency Workers (REW) and during this pandemic they have immunity through a provision in the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.

Liability Protection from States, CARES Act Coverage
Most states provide liability protection in the form of immunity for volunteer healthcare workers responding to a declared emergency. Moreover, section 4216 of The CARES Act (SEC 4216), passed in response to the COVID-19 emergency, provides that volunteer healthcare professionals engaged in the emergency response to COVID-19 “shall not be liable under Federal or State Law for any harm caused by an act or omission of the professional in the provision of health care services during the public health emergency declared by the Secretary of Health and Human Services.”

Virtual Help Line
In response to the pandemic, CCT created and fostered the idea of a help line for community members who need mental health crisis intervention or spiritual support. CCT is using an application called Grasshopper that supports the virtual call system we need. Providers are trained to use Grasshopper on both the computer and phone app. We have our own Grasshopper phone number through which providers receive and return calls. Providers do not use their personal phone numbers.
The CCT Help Line has two extensions: one for mental health callers and one for spiritual support.
The mental health extension offers confidential no-cost crisis intervention with licensed and trained Mental Health Practitioners for up to 3 sessions.
The spiritual health extension offers confidential spiritual support from experienced Spiritual Care Providers for up to 3 sessions. The Spiritual Resources Group sought community members with experience and recognized for cultivating their own spirituality and for gifts in compassionate listening. These volunteers are not to be considered as experts or authorities. Care providers will respect and be guided by the perspectives, values, goals and experiences of the person seeking support.  There will be no proselytizing or promoting of particular religious, spiritual, philosophical, moral, lifestyle, or other frameworks.

Training
Both groups of CCT Help Line providers were trained in a Psychological First Aid and Resiliency Building course, created for crisis intervention counseling. We have two retired psychologists and one retired psychiatrist who offer consultation, debriefing, and support to the Help Line providers. Procedural guidelines for use during calls were developed for the Mental Health Practitioners and Spiritual Care Providers.

Data
We developed a data collection survey to track the number, dates and times of calls received; areas of stress/concern expressed by Vashon residents; and referrals to mental health or social services made. Practitioners are not to use this form for clinical notes or to provide personally identifiable information.
A brief Essential Workers survey was created to collect information from island responders on compassion fatigue, secondary trauma, and burnout.

Group Support
We are setting up Zoom education and support groups (not therapy groups) for community members who would like to be part of a group while dealing with the uncertainty that comes with prolonged isolation, social distancing or positive test results:

• Resiliency building/coping groups
• Drop in parenting groups
• Essential workers support groups

Group facilitators are experienced retired mental health practitioners and/or school counselors. We are collaborating with the island schools to get referrals for youth groups during the summer months.

Community Awareness
To promote community awareness, the team developed a postcard which was mailed to all community members, listing the CCT Help Line number and other Vashon Island resources. One of the main objectives was to reach those not comfortable using the internet.

Articles about the CCT were published in the local newspaper, information about the CCT was shared on the local radio station and Vashon Town Hall. Additional postcards were delivered to strategic places on the island, such as the health clinic, the COVID testing site, the pharmacy, and the mental health counseling clinic.

The postcard distribution was effective, as the Help Line started receiving many more calls after cards were mailed and distributed.

Community Collaboration
CCT collaborates with existing island resources such as: mental health, substance abuse, and domestic violence organizations; the faith/spiritual community; the school district; and social services to assess community needs and gaps in social emotional support for community members. As social services channels become saturated, the need to provide this intermediary support is critical. Collaboration avoids duplicating services, increases surge capacity, and supplements local resources.

CCT Webpages: https://vashonbeprepared.org/en-us/MentalHealth
Working with VashonBePrepared, CCT created a website that includes mental health resources, coping strategies, and spiritual health resources in the form of poems, prayers, and spiritual practices. There are also links to relevant training and webinars.

Data Collection Survey:
https://docs.google.com/forms/d/e/1FAIpQLSeRnyn2iUc67NLz2Kj6p8JBp4FDo6PXxc3Xt50ePp2U-uiYRA/viewform?usp=sf_link

Essential Workers Survey:
https://www.surveymonkey.com/r/8BD6CWL

Beachcomber article:
Health and compassion for the mind and spirit
https://www.vashonbeachcomber.com/opinion/health-and-compassion-for-the-mind-and-spirit/

CCT postcard (Click to enlarge)

Community Care Team Leadership
Jinna Risdal, PhD (Chair) is a retired Therapist, Educator, and Administrator who lives on Vashon Island. She is a graduate of University of Colorado and Union Graduate School. As School Counseling Program Coordinator, she facilitated the design, development, and implementation of a Comprehensive School Counseling Program in a large, highly diverse urban school district. She wrote federal grants to increase funding for mental health resources in the district and served as the lead for the Crisis Team. As Coordinator for the Homeless Students Education Program, she ensured that the McKinney-Vento legislation mandates were implemented and wrote federal grants to increase program support. Jinna developed prevention curricula and taught graduate courses in School Counseling.

Carla Pryne is a retired Episcopal priest living on Maury Island. She is a graduate of Bowdoin College and Yale Divinity School. Over a 35 year ministry, she served 6 congregations in the Puget Sound area, including Church of the Holy Spirit, on Vashon Island. She was the founder and first Executive Director of Earth Ministry, a 28 year-old organization based in Seattle, developing networks and programs for faith-based stewardship of the earth.

Tom Craighead, MSW, Hospice Chaplain is a retired Episcopal Priest who resides on Vashon Island. He served congregations in Buffalo, NY, Vermont, and Port Orchard, WA. He earned an MSW with a focus in family mental health. As a hospice chaplain for 14 years, he visited patients and their families in their homes throughout Pierce and Kitsap counties, WA. He particularly enjoyed working with refugees from religion, and those who identified as agnostic or atheist.

Heidi Jackson is the Executive Director of the DOVE Project. She is a graduate of Seattle Pacific University She has an extensive background in finance and business operations. She has worked in various leadership positions within DOVE to support advocacy for survivors of domestic violence and the creation of prevention curriculum to stop violence before it starts. Her focus is on making sustainable programs that work toward systemic cultural change though relationships in our community.

Lori Lowrance has lived on Vashon for 23 years and became concerned about disaster preparation when CERT and VashonBePrepared were organizing.  She took the 8-week CERT course and then a refresher course a few years later.  Lori's employment background is in customer service, working for Pacific Research Labs on Vashon and for a computer manufacturer in Portland, OR.

Hilary Wogan MS, LMFT is a psychotherapist living on Maury Island in private practice on Vashon/Maury Islands.
She has been a licensed Therapist for 30+ years in California, Hawaii and Washington. Her work assists individuals heal and find their way to ease and peace in the world.
Compassion is at the heart of her work.
Areas of expertise: Advanced training in treatment of developmental and complex trauma. Extensive experience in crisis intervention, safety planning, needs assessment, and utilization of resources. Administrative and Supervisory experience in both clinical and educational settings. Assessment and treatment of domestic violence, emotional abuse, sexual abuse, elder and child abuse/neglect. LGBTQIA aware and sensitive. Giving back to the community is part of the fabric of my life.

External Advisors
Lynn Carrigan is a retired Social Work Professor from the University of WA School of Social Work and former licensed clinical social worker who trained as a Registered Emergency Responder with Seattle King County Public Health Medical Reserve Corps in 2008. Prior to teaching, her twenty years of clinical practice at Harborview Medical Center, Fred Hutchison Cancer Research Center, and Group Health Home Health and Hospice provided her with a strong background in trauma, grief and loss, death and dying, and medical ethics.
She joined the Vashon Community Care Team in 2006 and led that group after retirement in 2012 until 2015, aligning the CCT under the Vashon Medical Reserve Corps as per the Seattle PHMRC model.  Lynn was called back to service in March 2020 to assist Jinna Risdal temporarily in rebuilding the CCT for updated and remote operations. She continues to serve in an advisory capacity focusing on training materials and systems operations.

Wren Hudgins, PhD started professional work as a school psychologist (4 years) and then conducted a private practice for 20 years. Following retirement from that he went back to work for the Washington State Parks and Recreation Commission, managing their Critical Incident Response Program. On the volunteer side he has worked in the Red Cross system as a disaster mental health responder for 19 years and is now a supervisor in the that system. Along with others, he teaches the disaster mental health classes for the Red Cross.

Barry Grosskopf, MD is child survivor of the Holocaust, came to the US at five, obtained his MD at University of Miami, interned at Virginia Mason Hospital, and initiated National Health Service Corp’s first class as a GP and public health officer in Glenville, WV. He trained as a psychiatrist at UW then initiated projects to work with people with persistent mental illness, homebound elders, people with alcohol and drug addiction, PTSD, and victims of sexual abuse. He retired at 72 after working with the courageous Tulalip people. He continues to supervise and mentor psychiatry residents for UW.

About this Site
The Vashon Island Medical Reserve Corps and VashonBePrepared are making the information and documents on this website freely available with the hope of stimulating local action in rural and tribal America to combat the SARS-CoV2 epidemic. This is currently a beta version of content and documents- we welcome your questions and feedback which you can provide at: https://vashonbeprepared.org/en-us/MentalHealth