Definition of a Disaster

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					FEMA Crisis Counseling
      Program
   Anthony H. Speier, Ph.D.
     Definition of a Disaster
A disaster is an occurrence such as a
 hurricane, tornado, flood,
 earthquake, explosion, hazardous
 materials accident, war,
 transportation accident, mass
 shooting, fire, famine, or epidemic
 that causes human suffering or
 creates human need that the victim
 cannot alleviate without assistance.
    Classification of Disasters
 NATURAL VS HUMAN CAUSED
 DEGREE OF PERSONAL CONTACT

 VISIBLE IMPACT

 SIZE AND SCOPE

 PROBABILITY OF RECURRENCE
The Federal Emergency Response
             System
   Human Services Program
    •   Crisis Counseling Assistance & Training
    •   Cora Brown Fund
    •   Disaster Housing Assistance Program
    •   Disaster Legal Services
    •   Disaster Unemployment Assistance
    •   Individual & Family Grant Program
    •   Stress Management Program
    •   Department of Veteran’s Affairs
    •   Federal Financial Institutions
    •   Internal Revenue Service
    •   Small Business Administration Disaster Loans
    •   Social Security Administration
    •   US Department of Agriculture


    Foundations in Disaster Mental Health Operations, Unit Two: Federal Response to
       Disasters through Human Service Programs, Faculty Manual
                 Disaster Facts:
    The Realities of Disaster Mental Health Services

   No one who sees a disaster is
    untouched by it. (First hand and
    second hand victims)
   Two types of disaster trauma
     • Individual trauma – Stress & grief
       reactions
     • Collective trauma – Damages the bonds
       of the social fabric of the community.
       Increases fatigue and irritability, family
       conflict damages family ties.
       Disaster Facts Continued
   People pull together during & after a
    disaster – high activity/low efficiency
   Stress & grief are normal reactions to an
    abnormal situation – reactions are usually
    transitory.
   Emotional reactions relate to problems of
    living – abnormal & excessive disruptions
    to daily routines
   Disaster relief = second disaster
   People typically do not seek out mental
    health counseling services – self-reliance
    at all costs!
      Disaster Facts Continued
   Survivors reject help – “Others need
    it more than I need it.”
   Mental health services are “practical”
    rather than “psychological.”
   Tailor services to community norms.
   Supportive systems are crucial to
    recovery – vulnerable populations.
   Interventions must be consistent
    with the phase of the disaster.
      Critical Disaster Stressors
   Threat to ones life
   Threat of harm to one’s family
   Destruction of one’s home or
    community
   Significant media attention
   Witnessing other’s trauma
   Being trapped or unable to evacuate
  Individual Assistance & Recovery Resources Worksheet
If you need…           You can get…   From…
Food
Clothing
Housing
Furnishings
Medical Care
Emergency Funds
Legal Assistance
Employment Advice
Income Tax
Assistance
Property Cleanup
Home Repair/
Maintenance
Farm Repair/
Maintenance
Official Information
     Crisis Counseling Programs
   What is its purpose?
    • Provides support for direct mental
      health services for survivors of major
      disasters.
   Authority for Crisis Counseling
    • The Stafford Act authorizes funds for
      mental health services after a
      Presidentially declared disaster
      Crisis Counseling Programs
               Continued
   Types of counseling programs
    • Immediate Services (1-60 days)
    • Regular Services (9 months)
   Areas of special concern
    • Specific outreach to high-risk groups such as
      children, elderly, disabled, and disadvantaged.
    • Psychotherapy and prolonged clinical
      interventions are inappropriate for this
      program.
    • Consumer advocacy must not be confused with
      emotional support.
    Presidential Declaration & Federal
       Crisis Counseling Programs
   Immediate Services Plan (0-60 days)
     • Due 14 days after disaster declaration date to FEMA
     • Description of disaster and listing of the areas where
       services will be provided.
     • Description of state and local resources, capabilities, and
       why these resources can’t meet the disaster related
       mental health needs.
     • Description of disaster response activities to date
     • Needs assessment of persons requiring disaster mental
       health services
     • Program plan to meet the needs with special attention to
       high-risk sub-population groups such as elderly,
       children, and persons with disabilities (including a
       training plan.
     • Budget and budget narrative justifying expenditure
          Federal Crisis Counseling
            Programs Continued
   Regular Services Plan (9 months)\
    •   Builds on activities organized during the ISP
    •   Provide status of current response to date.
    •   Needs assessment
    •   Indicator data of numbers seen & types of problems
    •   Interventions used & planned by stage of recovery
    •   Attention to special population needs & interventions
    •   A clear and specific understanding of local community
        needs and recovery status
    •   A broad based survivor & community-level strategy that
        is responsive to changing needs through the disaster
        anniversary date
    •   A phase down strategy
    •   Budget justification & narrative
    •   Training and human resource strategy
    •   Evaluation plan
    The Purpose of Crisis Counseling Immediate
    Services Program is to Bring a Systematically
       Organized Response to a Significantly
                Disorganized Event

   Systemic – Multidimensional
    • Interagency
    • Cross Cultural
   Organized – Program Design
    • Staffing and Communication Paths
    • Focused Outcome
    • Strategic Utilization of Resources
   Response – Immediate from the event
    date
    • Sixty days post-declaration date.
  Model of for Disaster Intervention
              Programs
Cost (Person)
High $$$$$$$$$$$$$ Recovery   Counseling

      $$$$$$$$$$
                           Individual & Family
      $$$$$$$$              Crisis Counseling

       $$$$$$
                               Outreach

                  Natural Group Crisis Counseling
       $$$$          Community Education
       $$        Targeted Skill-Building Courses
                    Gatekeeper Training
Low $              Public Information
      Post-Disaster Mental Health
             Interventions

   Outreach and Casefinding
   Brief Treatment (Group or Individual
   Case Management
   Information and Referral
Cognitive Reactions to Disaster

   Trouble concentrating or
    remembering things
   Difficulty making decisions
   Preoccupations with the event
   Recurring dreams or nightmares
   Questioning of spiritual beliefs
    Affective Reactions to a Disaster

   Feeling depressed or sad
   Feeling irritable, angry, or resentful
   Experiencing anxiety or fear
   Feeling despair or hopelessness
   Feelings of apathy
   Feeling overwhelmed
Behavioral Reactions to a Disaster

   Isolation from others
   Problems with sleep
   Increased conflicts with family
   Hyper-vigilance, startle reactions
   Avoiding reminders
   Easily crying
   Increase or decrease in appetite
Physical Reactions to a Disaster
   Exacerbation of pre-existing medical
    conditions
   Headaches
   Hot or cold sensations in body
   Vague, generalized physical discomfort
   Hypertension, cardiovascular conditions,
    heart pounding
   Gastrointestinal distress
   Exacerbation of psychiatric illness
   Accelerated physical decline
   Fatigue or exhaustion
    Key Concepts to Remember
   The target population is normal
   Avoid mental health labels
   Be innovative in offering help
   Fit the program into the
    community
    Keys to Intervention in a Crisis
   No concept of mental illness
   No classification of people
   Focus on strengths and potentials
   Focus on support structure
   Assumes competence
   Active/directive caregiver
   Program/community fit
   Innovative in helping
        Intervention Strategies
   Learn local norms from community leaders
   Use bi-lingual and bi-cultural staff
   Allow time to gain acceptance in a
    community
   Be dependable, non-judgmental,
    respectful
   Recognize cultural variation in expressions
   Provide community education information
    in multiple languages
   Focus on problem-solving and concrete
    solutions
   Interpret facts, policies, and procedures
      State Level Program Operations Checklist
   Program design
     • What is the purpose of the program?
     • Does the program design reflect the scope of the
       disaster impact?
     • Is the program management and staffing consistent
       with:
         The environment and communities

         Socio-demographic norms

         At-risk population needs
     • Are multiple levels of interventions incorporated into the
       project?
         Crisis counseling to survivors

         Outreach to individuals and families

         Group and community education about disaster
           recovery
     • Are intervention strategies appropriate to the
       phase/stage of disaster recovery?
     • Does the program have a common identity across all
       disaster sites?
    State Level Program Operations
          Checklist Continued
   Data Collection
     • Have data collection forms been developed, distributed, and
       staff trained on how to use them?
     • Are the number and types of persons identified? (gender,
       ethnic/racial status, age/special population status)
     • Presenting issues for intervention identified?
          Confusion/disorientation

          Agitation/anxiety
          Depression

          Disaster fears

          Acting out/adjustment
          Substance abuse

          Information/referral
     • Can the type of assistance needed/provided be readily
       identified?
          Groups served (neighborhoods, schools, disaster
           responders)
          Types of concerns expressed

          Services provided (education, consultations)
     Disaster Coordinator Duties
   Coordinate agency coverage of disaster
    members regular duties while they are
    in the disaster response.
   Decide if teams outside the impacted
    area need to be mobilized and the
    duration of their response.
   Supervise disaster team operations
   Act as agency contact person for relief
    agencies
   Plan for transportation, food, and
    shelter needs of disaster team members
   Provide teams with special identification
    badges to identify them as emergency
    workers.
     Typical Crisis Counseling Outreach
                    Model
                                           Crisis Counseling Outreach
                                                 Team Supervisor
                                      (Licensed Mental Health Professional)



           Indigenous Outreach                                                     Experienced Crisis
             Workers (3-5 FTE)                                                  Counseling Staff (1-2) FTE


                                                                              Crisis Counseling Staff
    Outreach Worker Assignments
                                                                                   Assignments
                  Children & Youth
                                                                        Respond to survivor trauma and grief
                     Older Adults                                                    reactions
                 High Impact Areas                                                   In-service training
                                                                              In-home & community visits
Note: This is a representation of a program design structure. The actual number of staff and % FTEs is dependent on the scope of
        the disaster event. Many ISP/RSG projects use half-time staff or reassign staff to the Crisis Counseling Program.
Qualifications of Disaster Mental Health
                  Staff
             Examples of What It Takes
   Ability to remain focused
   Function well in confusing chaotic environments
   Have common-sense and can “think on their feet”
   Sees problems as challenges not burdens
   Can monitor and manage own stress
   Comfortable with value systems and life
    experiences different from their own
   Initiative and stamina
   Sensitive to cultural issues
   Be adept and creative
   Establishes rapport easily
    Knowledge, Skills, and Attitudes Essential
       for Disaster Mental Health Workers
   Understand Human Behavior in a Disaster
     • Uniqueness of individual response; phases of
       disaster response
     • Concept of loss and grief; post disaster stress
       and recovery process
   Interventions with Special Populations
     • Older Adults, children, people with disabilities
     • Cultural groups, disenfranchised persons
   Organizational Aspects of Disaster
    Response and Recovery
     • Key roles & responsibilities of agencies – local,
       State, Federal and volunteer
Knowledge, Skills and Attitudes Essential for
 Disaster Mental Health Workers continued
   Key Concepts of Disaster Mental
    Health vs Traditional Psychotherapy
    • Intervention style, assumptions,
      program design, service locale, and
      purpose
   Appropriate Assistance to Survivors
    & Workers in Community Settings
    • Crisis Intervention: age appropriate
      interventions, debriefing, group
      counseling, support groups, & stress
      management techniquess.
Knowledge, Skills and Attitudes Essential for
 Disaster Mental Health Workers continued
   Community-Level Mental Health Services
    • Case finding, outreach, mental health
      education, public education, consultation,
      community organization, advocacy, and use of
      media.
   Understand Stress Inherent in Disaster
    Work – Recognize it – Manage it
    • The “buddy system,” regular breaks, good
      nutrition, adequate sleep, exercise, deep
      breathing, appropriate use of humor,
      “defusing” experiences, debriefing after duties
      are over.
     Barriers to Successful Communication
   Preoccupation with your own concerns… not
    focusing on the person’s issues.
   Emotional Blocks… situation/ conversation evokes
    unexpected emotions within the helper.
   Hostility… being angry with the survivor or a
    carryover from a recent experience can distort
    what you are hearing.
   Past Experience… Assuming a “been there, done
    that” attitude results in less efficient listening.
   Performance Expectation… feel we need to have
    all the answers… when we don’t we panic and feel
    helpless or become reactive.
   Mind-wandering… fin yourself day dreaming and
    unable to pay attention to what is being said.
   Personalizing… interpreting the survivor’s moods,
    feelings, and comments as being directly related
    to you.
    Some Useful Phrases after a Traumatic Event
   You are safe now (if they actually are).
   It is understandable that you feel this way.
   It must have been really upsetting/ distressing to see
    (hear, feel or smell) that.
   I am sorry that it (the flood, fire, your child’s death)
    happened.
   It sounds like you are feeling sad (confused
    overwhelmed, scared, angry, exhausted).
   You are not going crazy.
   Your reaction is a normal (common, frequent, typical)
    response to an abnormal event.
   It wasn’t your fault (if you are sure about the
    circumstances).
   Things may never be the same, but they will get better
    and you can get better.
   D.J. DeWolf, 1991
    Clichés & Not-So-Useful Phrases
   It could have been worse.
   You can always get another house/
    pet/car…
   Everything will be all right.
   I know just how you feel.
   You need to get on with your life.
   You will get over it.
   The Lord gives and the Lord takes away.
   You can’t question God’s will.
   You were lucky.
   What you have to do is just stay busy.
   Crying doesn’t help; you have to be
    strong.
D.J. DeWolfe, 1991
         Disaster Recovery Outreach
                   Services
                   Common Human Needs
   To   express feelings
   To   get sympathetic responses to problems
   To   be recognized as a person of worth
   To   not be judged
   To   be treated as an individual
   To   make one’s own choices and decisions
   To   keep secrets about oneself


Adapted from Biestek (1957) The Casework Relationship and Compton, B.,
   (1989) Social Work Processes in Raiff, N.R. (1992) Curriculum for
   Community-based Adult Case Management Training
Elements of a Helping Relationship
   Purpose: Normative, operational, individual
   Concern for others: caring and communicating
    caring
   Commitment & obligation: commitment to a
    common purpose
   Empathy: being able to enter into feelings &
    experiences of the other person
   Genuineness and congruence: consistent and
    openness – behaviors consistent with realities



Adapted from Biestek (1957) The Casework Relationship and Compton, B.,
   (1989) Social Work Processes in Raiff, N.R. (1992) Curriculum for
   Community-based Adult Case Management Training
    Recommendations for Outreach
            Workers
   Workers must enjoy people and be
    confident
   Know how to handle dogs and other pets –
    knowledge about animals is good for
    “small talk.”
   Convey that you are here to help
   Wear comfortable clothes
   Work in pairs-male/female teams are good
   Follow up on mailings is a nice way to “get
    in”
    Recommendations, continued
   There are advantages to having a team
    that is diverse in age, gender, race, a life
    experience
   Be comfortable being in outside elements
   Develop a “script” of entry remarks that
    identify who you are and why you are
    engaging this individual in conversation
   Go with whatever the person says
    following your introduction – validate the
    person’s feelings
Adapted from DeWolfe, D.J., (1991) A Guide to Door-To-Door Outreach
   (unpublished paper).
    Disaster Recovery Outreach Services
                     Tips on Engagement

   Be open, friendly, caring
   Skillful use of body language
   Use active listening skills
   Establish trust
   Focus on strengths
   Treat secrets and disclosures matter-of-factly
   Don’t try to parent or impose your personal values
   Keep the conversation on track
   Pace the engagement process
   Be comfortable in talking about disaster responses
   Don’t be intrusive or mechanistic
   Be creative; offer hope


Adapted from Raiff, N.R. (1992) Curriculum for Community-based Adult Case
   Management Training
                      Worksheet #1
         Skills and Attitudes Suggested for Case
                       Management
Be open, friendly, and caring



Skillful use of body language



Use active listening skills



Establish trust




 ADULT UNIT II, Southern HRD Consortium for Mental Health/Center for Mental Health
 Services
           Worksheet #1 continued
   Skills and Attitudes Suggested for Case
                 Management
Focus on strengths



Treat “secrets” and “disclosures” matter-of-factly



Don’t try to “parent or impose your personal values



Keep the conversation on track


   ADULT UNIT II, Southern HRD Consortium for Mental Health/Center for Mental
   Health Services
            Worksheet #1 continued
    Skills and Attitudes Suggested for Case
                  Management
Pace the engagement process



Be comfortable/honest in talking about symptoms



Don’t let your approach be intrusive or mechanistic



Be creative; offer hope




 ADULT UNIT II, Southern HRD Consortium for Mental Health/Center for Mental Health Services
CRISIS INTERVENTION
       MODEL
      TUNE IN-EXPLORE-SUMMARIZE-
      FOCUS-EXPLORE ALTERNATIVES
         & RESOURCES-AGREE ON
        CONCRETE PLAN OF ACTION

Volunteer and Information Agency, Inc. 4747 Earhart Blvd, New Orleans,
                              LA, 76125
       Mental Health Facts and
     Vulnerabilities of Older Adults
   Older adults account for more than 25%
    of all suicides
   Males over age75 have the highest suicide
    rate of any age group
   Drug abuse in the form of multiple
    medications is common
   Older adults consume more prescribed &
    over-the-counter medications than any
    other age group
   Slower rates of metabolism increases the
    possibility of drug interactions and side
    effects
   Alcohol consumption is a serious problem
     Mental Health Vulnerabilities of
        Older Adults, continued
   The theme of loss permeates the life of many
    older persons
   Loss of life partner often results in social isolation
   Low self-esteem often follows retirement
   Caretaker role of ill spouse can lead to loss of
    one’s own lifestyle
   Death of significant others & peers is a reminder
    of one’s own limited mortality
   Loss of sensory abilities (hearing & eyesight) can
    result in symptoms of disorientation and paranoia
   Malnutrition and infections can alter body
    chemistry leading to disorientation and confusion

Adapted from Carol E. Blixen, R.N.
Older Adults Reactions to Disaster
             Events

   Environmental Stressors
    • Poor health
    • Physical disabilities (hearing, sight,
      mobility)
    • Needs assistance in daily living
    • Isolation
    • Poor support system
    • Limited income
Older Adults Reactions to Disaster
        Events, continued
   Coping Experience/Skills
    • Recent losses or cumulative unresolved
      traumas leave older adults at-risk for
      difficulty in coping with disaster
      aftermath.

    • Or successful coping in the past may
      give older adults a reservoir of skills
      that allow one to cope with adaptability
      and resilience
Older Adults Reactions to Disaster
        Events, continued
   Impact of Losses for Older Adults
    • Intense sense of grief over mementos,
      pets, plants
    • Feels unable to start over
    • Past losses re-awakened
    • Slower to respond to impact of the loss
    • Experience a long-term decline in
      standard of living
Older Adults Reactions to Disaster
        Events, continued
   Utilization of Assistance
    • Slower to admit full extent of their
      losses-may miss deadline for applying
      for aid
    • Isolation may contribute to lack of
      awareness of resources
    • Lack of transportation may limit mobility
    • Tend to under-utilize insurance
Older Adults Reactions to Disaster
        Events, continued
   Stress Symptomatology
    • Slower to recover psychologically and
      financially
    • Fear of loss of independence
    • Depression
    • Withdrawal
    • Apathy
    • Agitation
    • Sleep disturbance
    • Memory loss
    • Disorientation, confusion
Older Adults Reactions to Disaster
        Events, continued
   Interventions
    • Home visits/thorough assessment of
      losses
    • Assist with recovery of possessions
    • Suitable residential relocation
    • Re-establishing familial & social contacts
    • Assist with medical & financial
      assistance
    • Assist with ways to be involved with
      community recovery efforts.
    Main Components of Grief Reaction
      Relevant to Disaster Workers
   Disbelief
    • Initial reaction of grief as one come to terms
      with actual loss
   Questioning
    • Seeking reasons for the death
    • Making the death believable by knowing its
      cause
   Anger
    • Non-directional and emotional
    • Semi-violent
   Guilt/Blame
    • Seeking the source of responsibility for the
      disaster or death
    • Focused on self, others, or God/fate
    Main Components of Grief Reaction
      Relevant to Disaster Workers
   Desperation
    • Avoiding eye contact
    • Overwhelmed with resignation/dismay
    • Sense of hopelessness
   Powerlessness
    • Sense of loss of ability to impact life events
    • Increased emotional response
    • Multiple feelings of fear, hostility, love,
      guilt/hate



    V.R. Pine, (1996) “Social Psychological Aspects of Disaster Death”. In
       Living with Crisis After Sudden Loss, K.J. Doka, and J.D. Gordon,
       (Eds.)
     Cultural Sensitivity & Disaster
        Mental Health Services
   Cultural Sensitivity

Being aware of the various cultural
 groups affected by the disaster. This
 includes ethnic & racial groups
 hardest hit by the disaster, language
 barriers, and suspicion of the
 government
 Cultural Sensitivity & Disaster
Mental Health Services, continued
   Cultural Diversity

Includes social class, gender, race,
  ethnicity, and lifestyle
     Cultural Sensitivity & Disaster
        Mental Health Services

   Cultural Competency

Being aware of one’s own values, attitudes
 and prejudices; being committed to
 learning about cultural differences, and
 being creative, flexible, and respectful of
 others values and beliefs in our
 interventions and outreach approaches.
When contacting ethnic groups be
        sensitive to…
   Dominant language/English fluency

   Immigration experience and status

   Family values

   Cultural values and traditions
A Personal Cultural History

    Questionnaire

        Exercise
    Factors Affecting Differential Response &
        Recovery to Disaster in Children
   Development level of the child
   Pre-disaster mental health of the child
   Ability of the community to offer support
   Whether or not child was separated from
    parents
   Reaction of significant adults
   Communication between child and parents
   Belief about what caused the disaster
   The degree of damage/violence caused by
    the disaster
   The degree to which the child was directly
    impacted by the disaster
Potential Relationships That Comprise
  the Notion of Family for Children
   Child to natural parent, direct caregiver, and/or
    guardian
   Child to brothers and sisters, both those in the
    same household and living in other households
   Child to uncle, aunts, cousins, both within and
    distant from the disaster impact area
   Child to significant non-related adults
   Child to the world of their school (teachers, staff,
    and students
   Child to their community of worship (church,
    synagogue, etc.)
   Child to persons in their communities of
    reference (e.g., local neighborhood, village, town,
    city, county, etc.
    Basic Principles in Working with
                Children
   Be a supportive listener
   Be sensitive to the individual’s ethnic and racial
    experience
   Respond in a manner that is consistent with the
    child’s level of development
   Be aware of the child’s emotional status, is the
    child actively afraid or withdrawn
   Determine if the child is comfortable/ secure
    about his/her current surroundings & those of
    his/her parents, & other significant persons/pets,
    etc
   Assist the child in normalizing his experiences
   If you don’t know what to do or think you are
    making things worse, seek assistance from a
    child specialist or mental health professional.

				
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