Behavioral Health’s Response within the Family Assistance Center

1. Behavioral Health’s Response within the Family Assistance Center CRISIS COUNSELING PERSPECTIVE TRACY RICHARDSON/MA, PH.D ABD

2. Human Responses • May experience terror, fear, horror, helplessness, sense of betrayal or violation • Have distrust • Fear of people • outrage • Blaming others or individuals as being responsible for event • Desire revenge • Demand for justice • Feel the world is no longer secure (world view assumption) • “Evil/Bad things happen to good people”

3. Phases of Response & Reconstruction • Impact • Outcry • Disbelief, shock, and denial • Interaction with criminal justice system • Working-through process • Coming to terms with realities and losses • Reconstruction

4. Risk Factors- Population Exposure Model • A. Injured survivors; bereaved family members • B. Survivors with high exposure to disaster trauma or evacuated from disaster zones • C. Bereaved extended family and friends, first responders • D. People who lost homes, jobs, or possessions; people with preexisting trauma and dysfunction; special populations; other disaster responders • E. Affected people from the larger community.

5. Population Exposure Checklist • Identify direct victims and highly impacted families • Identify comparable groups for A, B, C, D, E in model • Identify cultural and ethnic groups and special populations present in A, B, C, D, E • Determine impact and mental health service needs for each group

6. Adult’s Reactions • Physical • Faintness, dizziness • Hot or cold sensation in body • Agitation, nervousness, hyper-arousal • Fatigue and exhaustion • Gastrointestinal distress • Nausea • Appetite fluctuation • Headaches • Exacerbation of pre-existing health conditions

7. Behavioral Reactions • Sleep disturbances and/or nightmares • Jumpiness, easily startled • Hyper-vigilance, scanning for danger • Tearfulness • Conflicts with family and/or coworkers • Avoidance of reminders of trauma • Inability to express feelings • Isolation or withdrawal from others • Increased use of alcohol or drugs

8. Cognitive Reactions • Confusion and disorientation • Poor concentration and memory problems • Impaired thinking and decision making • Traumatic bereavement

10. Emotional Reactions • Shock, disbelief • Anxiety, fear, worry about safety • Numbness • Sadness, grief • Helplessness, powerlessness, vulnerability • Irritability, short temper • Survivor’s guilt • Unpredictable mood swings

11. Children’s Reactions (1-5) • Heightened arousal and agitation • Generalized fear and anxieties • Cognitive confusion • Sleep disturbances • Unable to understand death as permanent • Somatic symptoms

12. School-Aged Children (6-11) • Responsibility and guilt • Sleep disturbances • Safety concerns • Aggressive behavior • Irrational fears • Close attention to parent’s anxieties and reactions • Concentration and learning problems

13. Pre-Adolescents and Adolescents (12-18) • Detachment from feelings • Shame, guilt, humiliation • Self-consciousness • Depression, social withdrawal • Decline in school performance • Desire for revenge • Rebellion at home or school

14. ROLE OF BEHAVIORAL HEALTH PROVIDER • COMPASSIONATE SUPPORT • PROVIDE INFORMATION • BOLSTER RESILENCY • HELP FAMILY MEMBERS TO COPE • ABILITY TO RECOGNIZE INVIDIVIDUALS WHO MAY HAVE PRE-EXISTING ISSUES OR EXTREME DISTRESS • PROVIDE ASSISTANCE TO VICTIM SUPPORT PROVIDERS (FIRST RESPONDERS)

15. ROLE OF BEHAVIORAL HEALTH PROVIDER • Behavioral assistance tailored to the communities in which we serve • Assistance is practical, flexible, empowering • Understand that law enforcement procedures, medical examiner’s protocols, disaster relief requirements, and criminal justice proceedings often confuse and distress survivors and their families. • Supportive Listening • Facilitate effective problem-solving of immediate concerns • Provide psychoeducational information regarding post-trauma reactions and coping strategies

16. Psychological First Aid • Comforting the distressed survivor • Addressing immediate physical necessities (dry clothing, fluids, food, shelter) • Supporting reality-based practical tasks • Providing concrete information about what will happen next to increase a sense of control • Listening to and validating feelings • Linking the survivor to systems of support • Normalizing stress reactions to trauma and sudden loss • Reinforcing positive coping strengths

17. Psychological First Aid • Contact & Engagement • Engage non-intrusively, in an understanding, compassionate manner • Safety & Comfort • Ongoing safety & emotional support • Stabilization (if needed) • Stabilize disoriented and/or overwhelmed survivors • Information Gathering: Current Needs and Concerns • Individualize, immediate needs (Maslow’s Hierarchy of Needs approach) • Practical Assistance • “What do they need right now?” (Regaining Sense of Control)

18. Psychological First Aid continues…. • Connection with Social Supports • Family connection, community resources access • Information on Coping • Helpful handouts on stress reactions, how to reduce distress, promote adaptive functioning • Linkage with Collaborative Services • Future continued coping strategy • Linkage to available resources if needed in the future

19. Group Exercise • Role Play Utilizing Psychological First Aid • A FAC has been opened after a powerful hurricane flooded entire coastal communities, displacing thousands of people. It’s now a day after the storm and the demand for services means clients must wait for many hours in a hot, humid gym in order to begin the process of filing claims for benefits. Tempers are short and rumors are flying about unfair distribution of resources. The Client is an older man in a yellow vest who is pacing around the staff break-room and muttering to himself. • Client Statements: • • I took this job so I could try to help these poor people and all they do is scream at me! • • I’m doing my best but there are just so many of them, and the paperwork for each case takes freaking forever to complete. I feel like it’s my fault. If only I could work faster. • • I know some of the questions are stupid but that’s not my fault! If they’d just answer them rather than complaining about them we could get them help a lot faster. • • Do they think I’m getting rich doing this job? Hah! I just answered an ad to make a little extra money now that I’m retired but this is definitely not worth it. I think I’d better quit before I punch someone or have a stroke. • • I’m really not up for doing this anymore. I’m just not able to cope. • • Sorry, ignore me, I’m just tired. Please don’t tell my supervisor I said any of this, okay? I don’t want to lose this job.

20. Crisis Intervention • 1. Promote Safety and Security • “May I get you something to drink?” • “Are you feeling comfortable/safe here?” 2. Identify current priority needs and problems and possible solutions “Describe the problems/challenges that you are facing right now.” “Who might help you?”

21. Crisis Intervention • 3. Assess functioning and coping • “How are you doing?” • “How do you feel you are coping with this?” • “How have you coped with stressful life events in the past?” • 4. Provide reassurance, normalization, psycho-education, and practical assistance • Support, reassurance, and acknowledgment and normalization of feelings • Survivor receives positive response from behavioral health workers • Psycho-education address specific reactions the survivor presents (arranging childcare, making a phone call, practical assistance)

22. Crisis Intervention Role Play • Role Play Utilizing Crisis Intervention • A FAC has been opened after a powerful hurricane flooded entire coastal communities, displacing thousands of people. It’s now a day after the storm and the demand for services means clients must wait for many hours in a hot, humid gym in order to begin the process of filing claims for benefits. Tempers are short and rumors are flying about unfair distribution of resources. The Client is an older man in a yellow vest who is pacing around the staff break-room and muttering to himself. • Client Statements: • • I took this job so I could try to help these poor people and all they do is scream at me! • • I’m doing my best but there are just so many of them, and the paperwork for each case takes freaking forever to complete. I feel like it’s my fault. If only I could work faster. • • I know some of the questions are stupid but that’s not my fault! If they’d just answer them rather than complaining about them we could get them help a lot faster. • • Do they think I’m getting rich doing this job? Hah! I just answered an ad to make a little extra money now that I’m retired but this is definitely not worth it. I think I’d better quit before I punch someone or have a stroke. • • I’m really not up for doing this anymore. I’m just not able to cope. • • Sorry, ignore me, I’m just tired. Please don’t tell my supervisor I said any of this, okay? I don’t want to lose this job.

23. Summary……….. • Family Assistance Centers • Serves as a safe place for families to grieve • Information resources for families • Facilitates family reunification • Behavioral Health Intervention • Psychological First Aid • Crisis Interventions

24. References • Mass Fatality Incident Family Assistance Operations, retrieved from https://ntsb.gov/tda/TDADocuments/Mass%20Fatality%20Incident%20Family%20Assistance%20Operations.pdf • Population Exposure Model: Adapted from DeWolfe, D. (2002). Mental health interventions following major disasters: A guide for administrators, policy makers, planners, and providers. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. • Mental Health Response To Mass Violence and Terrorism, retrieved from https://store.samhsa.gov/shin/content/SMA04-3959/SMA04-3959.pdf • Family Assistance Centers, retrieved 3/28/2017 from http://haleborealis.com/wp-content/uploads/2016/11/Family-Assistance-Centers_LeClair_McGuirk.pdf

25. References • Psychological First Aid Demonstration Project Preparedness and Emergency Response Learning Center (PERLC) Center for Public Health Preparedness (CPHP) School of Public Health University at Albany. Psychological First Aid Practice Scenarios Facilitator Guidelines. Retrieved from https://www.urmc.rochester.edu/.../Facilitator-Guidelines-and-Scenarios-9-26-16-final • Brymer, M, Jacobs,A, Layne, C, & et.al. Psychological First Aid, Quick Series. www.quickseries.com

26. Questions

27. Tracy Richardson/MA, PH.D ABD Community Services Manager Anderson-Oconee-Pickens Mental Health Center 864-965-9478 (office) 864-716-2332 (fax) 864-958-0908 (cell)