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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