In Times of Crisis : Supporting Others, Supporting Ourselves

1. In Times of Crisis:Supporting Others,Supporting Ourselves John Gaspari, LCSW Executive Director USC Center for Work and Family Life

2. Center for Work and Family Life Available Services: • Faculty and Staff Counseling • Faculty, Management and Departmental Consultation • Critical incident response • Work/Life Support • Family and Dependent Care: Consultation and Resources • Workplace Health and Wellness Programs

3. Role Expectations • Are you clear about your the role expectations you carry as a member of the CERT? • Can you imagine having any unfulfilled expectations or disappointments while functioning in this role? • How might the many other roles you play at any given time impact your role as a CERT member?

4. Unit Objectives • Psychological impacts to expect after a disaster – What happens for people? • How to work with the psychological impacts in your role – Providing psychological support. • Responder stress management and self-care.

5. Are We Psychologically Prepared? • For every physical injury, there may be 5-6 psychological injuries • This may overwhelm and impede our emergency and/or medical response.

6. Critical Incident • Exposure to a traumatic event in which both of the following were present: • The person experiences, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. • The person’s response involved intense fear, helplessness or horror. (DSM-IV TR)

7. Coping Mechanisms • People typically rely on past strategies to cope with new stressful situations • Past coping mechanisms can be functional or dysfunctional. • Degree of hardiness (resilience) has been identified as a characteristic that can buffer extreme stress in older populations • Children can be vulnerable because they have no experience or known patterns of actions as a response to the experience.

8. Into every life a little rain must fall ….. But what happens when there is a flood?

9. Psychosocial Impact – Considerations • Prior experience with a similar event • Prior trauma • The intensity of the disruption in the survivors’ lives • The resilience of the individual

10. Psychosocial Impact – Considerations • The length of time that has elapsed between the event occurrence and the present • Pre-existing vulnerabilities • Man-Caused vs. Naturally Occurring Events • Children/families • Seniors • Disabled • Bereaved • Health impairments • Women

11. Consequences of Critical Incidents Often include LOSS • Tangible Loss • Loss of loved ones • Loss of home • Loss of material goods • Loss of employment / income

12. Consequences of Critical Incidents Often include LOSS • Intangible Loss • Loss of safety / security (real or perceived) • Loss of predictability • Loss of social cohesion/connection/support • Loss of dignity, trust and safety • Loss of positive self-image/self-esteem • Loss of trust in the future, identity, independence • Loss of hope • Loss of CONTROL

13. Activity – What if I lost… • You have been given three cards each of three different colors: • Blue Card - write the name of a person close to you on each card • White Card - write down one of your favorite belongings • Pink Card - write down something you enjoy, an activity, or hobby. • After you have written on each card, place them face down on the table and shuffle them around. Close your eyes and pick three cards.

14. Activity – What if I lost… • These are the three things you will have lost in a disaster. • Discuss with the group how you feel about losing these things or people

15. Possible Psychological Reactions to a Large-Scale Emergency • Many people survive disasters without developing any significant psychological symptoms. • For other individuals, the reactions will disappear over time. “Just because you have experienced a disaster does not mean you will be damaged by it, but you will be changed by it.” (Weaver 1995)

16. Grief and Loss • Not an even process • Takes time • Can become stuck in the process • May spawn other problems • Nothing like T & T (Time and Talking)

17. Supporting Others

18. “We’re a community that believes in ‘love thy neighbor’, but right now we need to love our neighbors a little bit more.” • Man talking after devastating tornados ripped through his Tennessee neighborhood - 2/08

19. Role of Disaster Mental Health? • Primarily directed toward “normal” people who are responding normally to an abnormal situation • Improve resistance, resilience and recovery. • Identifying those at risk for severe social or psychological impairment • Identify those in need of additional or special services.

20. Role of Disaster Mental Health? • Mitigate post trauma sequelae • May prevent future problems • Helps people to handle problems in a way that does not create MORE problems • Convey sense of compassion and support for people.

21. Psychological Response to TraumaKey Concepts • Experience has shown that: • No one who sees a disaster is untouched by it. • Most people pull together & function during and after a disaster, but their effectiveness is diminished. • Most people do not see themselves as needing mental health services following a disaster and will not seek such services.

22. Psychological Response to TraumaKey Concepts • Experience has shown that: • Survivors respond to active, genuine interest & concern. • Survivors may reject disaster assistance of all types. • Disaster mental health assistance is often more practical than psychological in nature. • Social support systems are crucial to recovery.

23. Psychological Response to TraumaKey Concepts • While there may be specific disaster-related stressors, underlying concerns and needs are consistent across a range of traumatic events. These include: • A concern for basic survival • Grief and loss over loved ones & loss of valued and meaningful possessions • Fear & anxiety about personal safety & the physical safety of loved ones • A need to talk about events & feelings associated with the disaster, often repeatedly • A need to feel one is a part of the community & its recovery efforts

24. Phases of Disaster Honeymoon (community cohesion) llllllllllll Reconstruction (a new beginning) Heroic Pre-Disaster Disillusionment Working Through Grief (coming to terms) Threat EVENT Warning Inventory Trigger Events and Anniversary Reactions Time 1 to 3 days 1 to 3 years

25. Honeymoon (community cohesion) • Survivors may be elated • Happy just to be alive • This phase will not last

26. Disillusionment • Reality of disaster “hits home” • Loss and Grief becomes prominent

27. What Do You Think? • What main attributes and skills should a volunteer have when offering psychological support?

28. Essential Attributes and Skills • Empathetic • Non-judgmental approach • Kind • Committed • Flexible • Able to tolerate chaos • Good Listening skills • Patient • Caring attitude • Trustworthy • Approachable • Culturally aware

29. Intense Emotions • Are often appropriate reactions following a disaster • Can often be managed by community responders

30. Supportive Communication • Supportive communication conveys: • Empathy • Concern • Respect • Confidence

31. Activity – Supportive Statements • What are some supportive statements that you would find helpful if you were in pain, injured, and/or acute emotional distress.

32. Do Say… • Can you tell me what happened? • I’m Sorry • This must be difficult for you • I’m here to be with you

33. Activity – Unhelpful Statements • What are some statements that you would find unhelpful if you were in pain, afraid, injured, and/or dealing with tremendous loss.

34. Avoid Saying . . . • “I understand what it’s like for you.” • “Don’t feel bad.” • “You’re strong/You’ll get through this.” • “Don’t cry.” • “It’s God’s will.” • “It could be worse” or “At least you still have . . .”

35. Guiding Principles in Providing Psychological Support in Your Role • Protect from danger • Be direct and active • Provide accurate information about what you’re going to do • Reassure • Do not give false assurances • Recognize the importance of taking action • Provide and ensure emotional support

36. Crisis Intervention • Observe safe practices by showing concern for your own safety • Remain calm and appear relaxed, confident and non-threatening • You must look and act calm even if you are not

37. Goals of Psychological First Aid • Psychological first aid (PFA) promotes and sustains an environment of: SAFETY CALM CONNECTEDNESS SELF-EFFICACY HOPE

38. Psychological First Aid • Promote SAFETY: • Help people meet basic needs for food and shelter, & obtain medical attention. • Provide repeated, simple and accurate information on how to get these basic needs met.

39. Psychological First Aid • Promote CALM: • Listen to people who wish to share their stories and emotions, & remember that there is no right or wrong way to feel. • Be friendly & compassionate even if people are being difficult. • Offer accurate information about the disaster or trauma, and the relief efforts underway to help victims understand the situation.

40. Psychological First Aid • Promote CONNECTEDNESS: • Help people contact friends and loved ones. • Keep families together. Keep children with parents or other close relatives whenever possible.

41. Psychological First Aid • Promote SELF-EFFICACY: • Give practical suggestions that steer people toward helping themselves. • Engage people in meeting their own needs.

42. Psychological First Aid • Promote HELP: • Find out the types and locations of government & non-government services and direct people to those services that are available. • When they express fear or worry, remind people (if you know) that more help and services are on the way.

43. Psychological First Aid • DON’T: • Force people to share their stories with you, especially very personal details (this may decrease calmness in people who are not ready to share their experiences). • Give simple reassurances like “everything will be ok”, or “at least you survived” (statements like these tend to diminish calmness).

44. Psychological First Aid • DON’T: • Tell people what you think they should be feeling, thinking or doing now or how they should have acted earlier (this decreases self-efficacy). • Tell people why you think they have suffered by giving reasons about their personal behaviors or beliefs (this also decreases self-efficacy).

45. Psychological First Aid • DON’T: • Make promises that may not be kept (un-kept promises decrease hope). • Criticize existing services or relief activities in front of people in need of these services (this may decrease hopefulness or decrease calming). • Source: Center for the Study of Traumatic Stress

46. Anxiety • A state of intense apprehension, uncertainty and fear • Results from anticipating a threatening event • Intense anxiety = “fight or flight”

47. Agitation • Sometimes, despite our best attempts at active listening, people become agitated • It is usually not personal • This is their reaction to an extremely abnormal situation, and it has nothing to do with you

48. The Energy Curve Agitation Anxiety Tension Reduction Baseline

49. Elements of Escalation • Challenging authority or questioning • Refusal to follow directions • Loss of control, becoming verbally agitated • Becoming threatening

50. Elements of Escalation • Challenging Authority or Questioning • Answer the question • Repeat your request in a neutral tone of voice • Remember that an ounce of prevention is worth a pound of cure