The Basic Skills of Disaster Behavioral Health

1. The Basic Skills of Disaster Behavioral Health TADBHAC Joint Partnership With VDH/DMHMRSAS

2. Course Objectives • Identify range of responses to disasters • Explain survivor hierarchy of needs during a disaster • Identify methods for self care during disasters; Self-preparedness; Utilizing buddy system • Demonstrate the basic skills and techniques of psychological first aid

3. Course Objectives (Continued) • Explain concepts of crisis intervention, resilience, and using a strengths based model in resolving crisis • Demonstrate basic skills of crisis intervention • Identify the boundaries of your role • Identify indicators for referral and abuse reporting • Recognize special population considerations

4. Introductions

5. Role of Behavioral Health in a Disaster How does behavioral health work in a disaster? • Emergency operations center will take the lead in defining what the behavioral health response will be • Range of interventions; Immediate crisis intervention, psychological first aid, referral to services • CSB’s have an all hazards behavioral health response plan • Everyone is a resource

6. Role of Behavioral Health in a Disaster What is paraprofessional role in a disaster? • Liaison, greeter, disaster support worker • Serve as supportive, empathetic listener • Provide education and outreach • Refer individuals as needed Where might it occur? • Everywhere! • Point of dispensing sites, shelters, health care sites, hospitals emergency operations centers, feeding sites, first responder respitesites

7. Key Concepts of Disaster Behavioral Health • Normal reactions to abnormal situations • Avoid ”mental health” terms and labels • Practical assistance has a powerful psychological impact • Assume competence and resilience • Focus on strengths resources and potential • Encourage use of support network • Active, community fit • Innovative helping

8. Stress and Disasters

9. S T R E S S Stress is the body's physical and mental reactions to events and circumstances that frighten, excite, confuse, endanger, or irritate

10. A NORMALREACTION inNORMAL PEOPLE to anABNORMAL EVENT. Stress

11. Signs of Stress Reaction • Concentration problems • Anxiety • Identification with victims • Flashbacks • Difficulty sleeping • Changes in eating habits • Changes in working habits

12. Stress • Good Stress/Bad Stress • Fight/Flight/Freeze/Faint Reaction The next slide will be a test of your observational skills in identifying the subtle cues of stress. Look closely….

13. Stress Reactions to a Disaster * Indicates a flag for professional referral

14. Factors Influencing The Emotional Impact Of A Disaster Disaster individual/community worker Characteristics characteristics characteristics ________________________________________________________________ With warning v. Individual expectations/ Without warning characteristics experience Time of day and social support diversity Duration systems Geographic diversity/ physical/emotional Location demographics health Scope of impact disaster history personal issues Natural v. Previous trauma media coverage Man-made Post-disaster communications impact of disaster on them Environment Centralized v. Decentralized

15. Maslow’s Hierarchy of Needs Self Actualization Self Esteem Social Affiliation Personal Safety Physiological Needs

16. Phases of Recovery in a Disaster Situation • Impact • Heroic • Honeymoon • Inventory • Disillusionment • Reconstruction

17. Assignment Think about advice or support you received during the disaster you described in the introduction. What was helpful? What would have helped?

18. Activity 1: Disaster Charades • Break up into 6 equal groups • Using the previous slide indicating the phases of recovery from a disaster your facilitator will assign your group one phase of a disaster. • Without speaking your group will act out that recovery phase to the larger group to get them to guess the correct recovery phase.

19. Basics of Psychological First Aid

20. Psychological First Aid Protect Direct Connect

21. Summary of Basic Principles of Psychological First Aid: Protect + Direct + Connect • Contact and engagement • Safety and comfort • Stabilization

22. Activity 2: Psychological First Aid • Break up into 4 groups • Using page 10 in the manual using concepts 1 and 2 only discuss the disaster scenario given to you by your facilitator • Answer the two questions below in your group: • What would you be doing to respond to their needs for protection and comfort? • What have you found comforting in your own disaster? • Ask one person in your group to report to the larger group your disaster and a summary of your discussion

23. Summary of Basic Principles of Psychological First Aid: Protect +Direct + Connect • Information gathering: current need and concerns • Practical assistance.

24. Protect + Direct +Connect Summary of Basic Principles of Psychological First Aid: • Connection with Social Supports • Information on Coping • Linkage with Collaborative Services

25. Do’s of Psychological First Aid • Offer respect. Politely observe first, don’t intrude. Then ask simple respectful questions to find out how you may be of help. • Be prepared. Affected people may avoid or cling to you. • Speak calmly. Be patient, responsive, and sensitive. • Speak clearly. Use simple, concrete terms; don’t use acronyms. If necessary, speak slowly. • Point out strengths. Acknowledge the positive features of what the person has done to keep safe and reach the current setting. • Deal with immediate needs. Adapt the information you provide to directly address the person’s immediate goals and clarify answers repeatedly as needed. • Share helpful information. Give information that is accurate and age-appropriate for your audience. If you don’t know, tell them this and offer to find out.

26. Don’ts of Psychological First Aid • Don’t be a mind reader. Do not make assumptions about what the survivor is thinking, feeling or experiencing. • Don’t assume trauma. Do not take for granted that everyone exposed to a disaster will be traumatized. • Don’t pathologize. Do not label anyone with symptoms or diagnoses. • Don’t talk down to a survivor. Do not patronize survivors, or focus on their helplessness, weaknesses, mistakes, or disabilities. • Don’t assume they need you. Do not think that all survivors want or need to talk to you. • Don’t debrief. Do not probe for painful or gory details of what happened. • Don’t spread rumors. Do not speculate or offer unsubstantiated information. • Don’t be faddish. Do not suggest fad interventions. Stay with the tried-and-true basics of meeting immediate needs with respect and sensitivity.

27. Crisis Intervention

28. Crisis • Distinct From Trauma & Disorder • Turning Point • Momentous Decision • Danger and Opportunity

29. Goals of Crisis Intervention Enhance Opportunities Stabilize Reduce Dangers

30. Steps in Crisis Intervention • Crisis intervention typically involves five components: • Promoting safety and security (e.g., finding the survivor a comfortable place to sit, giving the survivor something to drink) • Exploring the person’s experience with the disaster (e.g., offering to talk about what happened, providing reassurance if the person is too traumatized to talk) • Identifying current priority needs, problems, and possible solutions • Assessing functioning and coping skills (e.g., asking how he or she is doing, making referrals if needed) • Providing reassurance, normalization, psycho education, and practical assistance

32. Basic Skills of Crisis Intervention • Active listening • Reflecting • Normalizing • Prioritizing • Assessment • Stress management • Holding the bucket

33. Holding the Bucket • People need to tell their story and they need you to listen while they do • Pace your breathing with speaker and then begin to slow them down • Body language and eye contact are a must for interaction • Do not interrupt/intrude on another counselor • Allow one to vent with out trying to defend or bash • Resistant to self-disclosure… ask about spouse, children (coping with?)

34. Crisis Intervention Strategy IThe LUV Triangle: Reach Out With LUV

35. Using the LUV Triangle

36. LUV Triangle: Listen • Face and give the person your undivided attention. • Lean toward the person and make eye contact.

37. LUV Triangle: Understand • Repeat or paraphrase what the person is saying. • Check your understanding.

38. Understanding and Responding Empathetic Response leads • So you feel . . . • I hear you saying . . . • I sense that you are feeling . . . • You appear . . . • It seems to you . . . • You place a high value on . . . Helpful Response Leads • So. . I am listening • Tell me more about that… • Sounds like talking about that is hard for you…. • Sometimes talking about it helps…. • Sounds like you are angry about that ……

39. LUV Triangle: Validate •Offer minimal encouragers, such as the “lassie twist.” • Show your faith in the person by not giving glib advice.

40. Activity 3 - Part 1 • Divide into same pair grouping from introduction activity • Have each person take 5 minutes as the survivor describing their own experience in their recall of September 11th, hurricane Katrina, or other disaster situation. • The partner will do active listening, getting the person to elaborate by reflecting and using the LUV triangle. • Take the entire 5 minutes for that speaker, then switch roles for another 5 minutes.

41. Activity 3 Part 1 – Process Recall • What was it like to have someone give you their undivided attention for 5 minutes? • What non-verbal/body language signals let you know they were interested in what you said? • What was it like to actively listen for a whole 5 minutes? • How did you get them to elaborate? • What do you understand about their personal experience in that disaster?

42. Activity 3 Part 2 - Listening When Emotionally Loaded - Directions: • Divide into pairs; have each person take 5 minutes. • Each partner will do active listening, getting the person to elaborate by reflecting or just sitting silently while they sort out what they want to say. • Take the entire 5 minutes for that speaker, then switch roles for another 5 minutes. Scenario: • Imagine that you are a passenger on flight 93. You have a cell phone and can make one call. • Who do you call? • What do you say? • What do you hope to hear?

43. Activity 3 - Part 2: Process Recall • How was this compared to the previous exercises? • What was it like to listen to what someone else had to say? • How would you help a family member who had/had not been called by the passenger? • How do you think doing disaster work might change your perceptions of your relationships?

44. Crisis Intervention Strategy IIFinding the Survivor: Resiliency

45. Ask “getting through” questions • "How did you get yourself to do that?" • "What did you draw from inside yourself to make it through that experience?" Ask “making meaning” questions • “As you begin to make more sense of this, what information have you learned so far?” • “What advice would you give somebody who was going through what you faced?”

46. Crisis Intervention • Crisis intervention typically involves five components: • Promoting safety and security (e.G., Finding the survivor a comfortable place to sit, giving the survivor something to drink) • Exploring the person’s experience with the disaster (e.G., Offering to talk about what happened, providing reassurance if the person is too traumatized to talk) • Identifying current priority needs, problems, and possible solutions • Assessing functioning and coping skills (e.G., Asking how he or she is doing, making referrals if needed) • Providing reassurance, normalization, psycho education, and practical assistance

47. Activity 4 – Crisis Intervention • Break up into pairs • Using the scenarios from Activity 2 role play a crisis intervention scenario with your partner using the information on the previous slide as a guide • Take turns with each of you being the victim and the helper

48. Indicators for Referral to Professionals • The person or family member reports severe deteriorated function since the disaster event (unable to feed self, dress, care for children, perform household tasks, etc) • The person or family member reports substance abuse starting after the disaster event. • The person is experiencing severe anxiety episodes interfering with ability to engage in recovery • The person or family member reports uncontrollable crying, muteness, feelings of unreality, is hearing voices or seeing things or experiencing ongoing paranoia • The person is verbally indicating a desire to retaliate against perceived sources of threat (wanting to beat up people who resemble terrorists, etc) • The person has a pre-existing mental illness, developmental disability or severe physical illness that is relapsing (refer to pre-disaster counselor or provider)

49. Exercise - Referrals Scenario: • The 7 year old tells the outreach team that the parent just stands at the stove and stares but doesn't cook, peanut butter and jelly are all the child knows how to fix. The milk in the fridge stinks and so does the meat. The parent has no prior history of mental illness, but now stays in bed most days. S/He is doing no salvage, the downstairs was flooded but the bedrooms upstairs are ok. S/He separated about two months ago when the partner ran off with someone else. Questions • What information is important to gather here? • What resources would you mobilize?

50. Are You Ready?Personal Preparedness As a Responder