Disaster and Crisis: Social Work Responses to the Impact of World Events

1. Disaster and Crisis: Social Work Responses to the Impact of World Events Helen Wilson Harris, LCSW

2. Eleanor Roosevelt, You Learn By Living • “Courage is the strength to face pain, act under pressure, and maintain one’s values in the face of opposition. You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself: ‘I lived through this horror. I can take the next thing that comes along.’”

3. Psalms 34: 19 • “Many are the afflictions of the righteous: but the LORD delivereth him out of them all.”

4. Objectives: • Examine the nature of uncertainty, crisis, stress and grief that come with disaster • Differentiate between crisis and grief • Develop specific helping strategies for social workers assisting clients to manage disaster and tragedy • Develop specific strategies for social workers assisting others through crisis. • Review self help strategies.

5. Sources: • Coping with Public Tragedy ( 2002 Hospice Foundation of America) Edited by Marcia Lattanzi-Licht and Kenneth Doka • The National Center for PTSD, Special Edition, Disaster Assistance (2001) • Growing through Grief after Sudden Loss (1999 Hospice Foundation of America) Edited by Kenneth Doka

6. Disasters, Trauma, Public Tragedy • Disaster: collective traumas…according to Barton, “collective stress…members of a social system fail to receive the expected conditions of life due to external or internal sources • Trauma: extraordinary events that threaten survival • Public Tragedy: large scope with which the public identifies Doka, 2002

7. What is your first memory of public disaster or tragedy? • The assassination of President Kennedy? • MLK Jr? Robert Kennedy? • Mount Carmel? • Columbine? • Oklahoma City? • 9/11? • A natural disaster?

8. Public Tragedies in our Living Rooms • We live in an increasingly small world • Major events have global impact, including impact on our lives • The media brings distant events into our living rooms • Live and constant coverage immerse people in the details of tragedy • Our community is called on to respond to the needs of our neighbors

9. Layers of stress and concern: • Fear and anxiety with uncertainty of future • Sense of helplessness and feeling out of control • Normal life stressors of job and family may continue • Exacerbation of grief that comes with losses…death, moves, relationships… • Confusion from losing the assumptions we have about the world as a safe and predictable place • Multiple funerals and images of the grief of others

11. Understanding the phases of tragedies: • The initial event, early aftermath…i.e. Crisis Phase • The short-term aftermath…i.e. Processing Phase • The long-term aftermath…i.e. Adaptation Phase Licht and Doka

12. The Processing Phase…. • The folks at Seventh and James are still in crisis but are beginning to experience safety and the meeting of their basic needs. • Many are now beginning to try to make sense of this. The prevailing questions will be “what happened?” and “why?” as well as “what now?”

13. Crisis Phase: On site and here when a secondary crisis occurs • First responders • Safety: Police, Firefighters • Medical Response: EMT, Doctors and Nurses • Issues are safety, preservation of life, ending the crisis

14. Processing Phase • Tragedies affect many people: survivors, witnesses, first responders, bereaved, later responders, and members of the community • Responses will vary significantly and may include physical response, emotional reactions, cognitive reactions, and spiritual reactions. Lattanzi-Licht and Doka

15. Crisis Management means: • First focusing on basic needs: Shelter, safety, sustenance, information, protection • Second, allowing those affected to begin to figure out what happened…tell their story, process the event and its meaning for them. • Always validate and normalize the responses ….listen carefully…reflect the language

16. The gifts of time and presence…….

17. Assessment is essential • Hearing the story will help you assess the needs and the strengths of each person (Strengths include their resilience…how they have managed crisis is times past…) • Listen each time as though it is the first time you heard the story • Assess strengths…support system available to the survivor • Assess spiritual beliefs/source of strength • Be careful of trite, glib religiosity

18. Adaptation Phase • Part of your assessment will include awareness of how long you will be available to help • Contract for work and for referral • Remember that crisis work eventually leads to grief work which is LONG term • Encourage the use of ritual and the arts to personalize the experience and provide formal, structured support. Lattanzi-Licht and Doka

19. How Long Will This Take? • The Adaptation Phase for the survivor may take years • Contract for the time you will be able to be present • Make referrals as needed • There is NO end point or closure

20. Avoid the term “letting go…” • People do not “let go” of memories or loved ones or dreams or wishes… • There is great resistance to “letting go.” It feels like giving up. • We do, however, over time, learn how to weave together the threads of our lives • A better metaphor is to integrate the relationship and the event into our lives. (These folks may not be ready to believe this….)

21. Each relationship and experience becomes part of who we are….

22. Concrete ways of helping… • Provide material goods: Provide your time and listening ear • Participate in your community’s disaster response team/disaster planning efforts • Network with voluntary organizations to work together to respond to disaster • Give blood • Develop in your workplace organizational policies to support employees during times of crisis

23. Debriefing Tips….the beginning of counseling…. • Protect the privacy of survivors and their families • Provide support as families get new and painful information • Plan and publicize healing ceremonies • Provide information on coping strategies • Be careful about providing information to the media • Help the helpers… Lattanzi-Licht and Doka

24. Critical Incident Stress Management… • Mitchell model to help first responders • Follows a traumatic event • Coping skills are overwhelmed • Goal, to prevent or limit development of PTSD • Provide distance • Demobilize or debrief • Lattanzi-Licht and Doka

25. Debriefing includes… • Explain process and ground rules (not psychotherapy…not operational critique) • Allow description of what happened and respective roles • Explore “first thoughts” and event processing • Facilitate ventilation: What was worst? • Identify symptoms of distress • Normalize crisis reactions • Teach stress management and coping skills • Summarize, provide follow up as needed Doka

26. Other options: • Defusing….small group discussion of traumatic event • Informal • Held immediately after an incident • Designed to reduce tension • Focus on facts of the crisis and reactions • Offer family/organizational consultation • Offer follow/up and referral Lattanzi-Licht and doka

27. Other Crisis Intervention Models • Beverly Raphael: When Disaster Strikes • Armstrong, O’Callahan and Marmer’s Red Cross adaptation of CISD: Multiple Stressor Debriefing Model • National Organization of Victim Assistance (NOVA): Safety and security, ventilation and validation, prediction and preparation • Lattanzi-Licht and Doka

28. Resources • www.hospicefoundation.org • www.whyy.org/widerhorizons/caringcom.html • www.redcross.org/services/disaster • www.nvoad.org (national voluntary organizations involvement in disasters) • www.imhi.org/dealing_with_disaster.html for helping children with disaster

29. Government Agencies…. • Federal Emergency Management Agency (www.fema.gov) • Robert T. Stafford Disaster Relief and Recovery Act: Center for Mental Health Services within Substance Abuse and Mental Health Services Administration • Small Business Administration • Disaster Unemployment Assistance • IRS, USDA

30. Not-For-Profit Organizations • National Voluntary Organizations Active in Disaster • American Red Cross (www.redcross.org) • National Organization for Victim Assistance • Salvation Army • Mennonite Disaster Service • Church related disaster response services

31. Professional Organizations • American Academy of Experts in Traumatic Stress (www.aaets.org) • Association of Traumatic Stress Specialists (www.atss-hq.com) • International Critical Incident Stress Foundation, Inc. • The International Traumatology Institute • Hospice Foundation of America (www.hospice foundation.org) • National Hospice Organization

32. Other Resources • American Psychological Association Disaster Response Network (www.apa.org) • America’s Heroes of Freedom (www.americasheroes.us) • Anxiety Disorders Association of America (www.adaa.org) • Association of Death Education and Counseling (www.adec.org)

33. Let others participate in helping as well…. • Ask for help and support • Take tasks one at a time • Practice good self care….eat healthy, take breaks, rest, exercise, look for the positive • Engage in activities that are relaxing for you….sitting by the water, taking a walk, spending time with a favorite pet, listening to music, prayer, Bible reading • Do something….give money, blood Natl Center PTSD

34. Turn off the news…. • Distract yourself by doing something you enjoy. It is not wrong to laugh again. You may be the one who can set the example for others that self care helps us continue to give to others.

35. Helping the Children….

36. Gear interventions to the child’s age and developmental level…. • For very young children, keep routines as much as possible, avoid separations, maintain calm, limit exposure to the trauma, expect regression, help provide language for the feelings, and play, play, play to enable the child to play out the situation. National Center for PTSD

37. For young to latency age children • Listen to the telling and retelling • Allow feelings, including fear • Limit exposure • Expect regression and acting out • Set limits for safety • Maintain routines • Play, play, play it out • National Center for PTSD

38. And then there are teens…. • Listen, listen, listen • Provide contact with peers • Affirm feelings; model seeking support • Give them something positive to DO • Encourage activities they enjoy with others • National Centger for PTSD

39. When is it time for referral? • Consider grief complications…ie suddenness of the death, troubled relationship, violence, arousal of fear • Consider support available • Consider coping skills and other stressors • Consider length of difficulty…i.e. duration of distress • Always assess for suicidal ideation.

40. Grief follows Crisis…. • During the Adaptation Phase, grief begins to manifest itself • Grief includes emotional, physical, social, intellectual and spiritual responses to loss • Loss can include loss of safety, loss of assumptions about the world, loss of relationships, loss of loved ones, loss of property, etc.

41. Physical Grief • Physical sensations….lump in throat, tightness in chest, weak knees, etc. • Experience of cold…blood flow to internal organs makes extremities cooler • Increased vulnerability to illness because of stress to the immune system • Increased vulnerability to accident because of cognitive distractability

42. Emotional responses to grief… • Most models tell us about the feelings of grief… • Shock/denial • Anger • Bargaining • Despair • Acceptance • And what about guilt, sadness, loneliness?

43. Cognitive impact of grief…. • Shorter attention span • Difficulty learning new material • Difficulty concentrating • Low energy

44. Social implications of grief… • Those who are bereaved feel robbed…and that experience can distance them from others • No one understands • I’d rather be alone • Laughing is too hard

45. Spiritual Implications….Faith and practice • Expectations of others (and often of ourselves) that Christians have hope, and faith, and strength….. • Translates to an expectation that Christians aren’t anxious, and shouldn’t be sad….. • So, Christians should handle anything…and do it joyfully and with celebration.

46. The truth is…… • Our faith and rituals ARE a great source of strength to us. • AND we mourn…and we hurt…not as the world mourns…but mourn we do.

47. Defusing PTSD….and then….