Populations with Special

1
Populations with Special

• Considerations

Midwestern Regional Training May 4 6
Chicago, IL
2
Possible Populations with Special Considerations

• Children
• Elderly/middle-
• aged
• Disaster workers/first
• responders/
• medical staff
• Trauma survivors

• Ethnic/cultural groups/minorities
• Immigrants migrant workers
• Refugees
• Individuals with disabilities (medical and
  behavioral)

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Possible Populations with Special Considerations
(cont.)

• Victims of domestic violence
• Families of first responders
• Media

• Victims who have become disaster workers/first
  responders/
• counselors
• Clergy/spiritual leaders

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Training for Work with Special Populations
Includes

• Competence in listening and communication
• Assessment that is appropriate to the population
• Established interventions to reduce distress
• Full understanding of the context to determine
  the appropriateness and feasibility of specific
  interventions.

5
Incorporating Populations with Special
Considerations into Disaster Planning

• Involve key members of each special population
  within an advisory group or Disaster Planning
  Consultation Board
• Identify specific needs as perceived by community
  members for inclusion into disaster plans.
• Manson, S. Health Care and Older Ethnic
  Minorities A Guide for Integrating Culture and
  the Clinical Process. Denver University of
  Colorado Health Service Center for Needs
  Assessment Study, 1995.

6
Collaboration with Existing Local Resources

• Local resources may help staff to understand
  indigenous perceptions of suffering, illness,
  loss, pain, and healing
• Collaboration with traditional healers is
  important
• Local leaders may help to endorse the program and
  identify solutions to problems
• Local leaders may help to build or rebuild social
  support networks, and act as cultural brokers

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Cultural Sensitivity, Competency, and Diversity
in Disaster Behavioral Health Services

• Sensitivity
• Being aware of the various cultural groups
  affected by the disaster. This includes ethnic
  and racial groups hardest hit by the disaster,
  language barriers and attitudes towards
  outsiders, including the government

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Cultural Sensitivity, Competency, and Diversity
in Disaster Behavioral Health Services (cont.)

• Competency Being aware of ones own values,
  attitudes, and prejudices being committed to
  learning about cultural differences and being
  creative, flexible, and respectful of others
  values and beliefs in interventions and outreach
  approaches
• Diversity Includes social class, gender, race,
  ethnicity, and lifestyle.

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Recommendations for Working with Populations with
Special Considerations

• Utilize culturally competent skills
• Utilize the population with special
  considerations as disaster workers/first
  responders/ medical staff
• Assess community members and individuals for
  relevant cultural and traditional mores.

Manson, 1995
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Recommendations for Working with Populations with
Special Considerations

• Learn some of the language, at least the commonly
  used words.
• Find a mentor who is known to the community
• Enlist key members of the community
• Use a natural setting to collect information go
  into the community

Manson, 1995
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Recommendations for Working with Populations with
Special Considerations

• Meet with special population members to identify
  specific needs of the community
• Learn more about the native healers-or the
  general way the community uses and accesses
  health care

Manson, 1995
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Recommendations for Working with Populations with
Special Considerations (cont.)

• Learn all about the community, strengths and
  weaknesses
• Use the communication style of the community
• Maintain your awareness as you work with a
  special population.
• 
  

Manson, 1995
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Values Intrinsic to Working with Populations with
Special Considerations

• Respect the needs, resources, and strengths of
  the person and community
• Ensure staff is grounded in knowledge of care
  appropriate for disasters
• Recognize the legitimacy of multiple perspectives
  on trauma and related concerns.

Danieli, Y., et al. Guidelines for International
Training in Mental Health and Psychosocial
Interventions for Trauma Exposed Populations in
Clinical and Community Settings. Task Force on
International Trauma Training of the
International Society for Traumatic Stress
Studies, 20k02
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Values

• Address cultural issues within the training and
  management of the program
• Allow indigenous structures to take a leadership
  role over time in directing the process
  psychosocial interventions may not be effective
  if not supported by a stable social environment
• Ensure that personnel are practically and
  mentally prepared for conditions in the field.
• 
  

Danieli, 2002
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Values, cont.

• Keep in mind that every client or victim may be a
  part of a population with special considerations
• When appropriate, utilize members of a population
  with special considerations as examples of
  resilience
• Use the populations resources
• Be non-conventional
• Include rather than exclude

Danieli, 2002
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Intervention Strategies

• Learn local norms from community leaders
• Use bilingual and bicultural staff
• Allow time to gain acceptance in a community
• Be dependable, non judgmental, respectful.

Adapted from CMH Disaster Crisis Mental Health
Populations with Special Considerations
presentation.
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Intervention Strategies, (cont.)

• Recognize cultural variation in expressions of
  grief or trauma reactions
• Recognize varying cultural acceptance of mental
  health interventions
• Provide community education information in
  multiple languages
• Focus on problem-solving and concrete solutions
  

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Populations with Special Considerations

• Ethnic/Cultural Groups
• Minorities

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Importance of Cross-Cultural Competency

• The population of the United states is becoming
  increasingly diverse
• In year 2000, 25 of the U.S. population was
  classified as minority
• By year 2050, it is predicted that more than 50
  of the U.S. population will be from a
  non-European background

U.S. Dept. of Commerce (2001), Current population
survey, 1998, 1999, 2000, Washington, DC U.S.
Government Printing Office
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Ethnic/Cultural Groups/Minorities

• Cultural differences lead to different
  health-seeking behaviors
• Tendency for more physical complaints as
  expressions of psychological distress
• Stigma toward mental health/substance abuse
• Previous exposure to trauma may worsen coping
  with current trauma
• Difficulty navigating benefit system.

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Factors of Ethnic/Cultural Groups/Minorities
Influencing Disaster Response and Recovery

• Dominant language used within households
• Family structure
• Willingness to access services
• Location of services

Adapted from CMHS Disaster Crisis Mental Health
Populations With Special Considerations
presentation
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Basic Principles in Working with Ethnic/Cultural
Groups/Minorities

• Use bilingual and bicultural workers
• Access to trained interpreters
• Maintain awareness of immigration experience and
  status
• Identify and utilize family values and support
  systems
• Be cognizant of cultural values and traditions.

Adapted from CMHS Disaster Crisis Mental Health
Populations With Special Considerations
presentation
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Basic Principles in Working with Ethnic/Cultural
Groups/Minorities, (cont.)

• Recognize respect differences
• Understand cultural definitions of behavioral
  health, well-being, coping, and recovery
• Provide services and information in primary
  languages.

Adapted from CMH Disaster Crisis Mental Health
Populations with Special Considerations
presentation.
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Populations with Special Considerations Refugees

• 35 million people forced from their homes by
  violence repression
• 21 million internally displaced
• Number of countries producing massively
• uprooted populations
• doubled
• 2,000,000 refuges in
• U.S. since 1980
• 72,515 admitted in FY 2000

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Populations with Special Considerations

• Individuals with Disabilities
• Individuals with mental illness
• May worsen preexisting conditions
• New trauma may exacerbate existing history
  of trauma
• Loss of social support
• Interruption of treatment
• Cannot navigate benefit structure
• Individuals who are homeless
• Preexisting problems with social support
• Concomitant problems (medical substance abuse,
  psychiatric).
• The most vulnerable are hurt worst in most
  disasters
• Easily overlooked and already marginalized.

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KEY CONCEPTS TO REMEMBER

• The target population is normal
• Avoid behavioral health labels
• Be innovative in offering help
• Fit the program into the community
• Be aware of the cultural differences of each
  special population.
• Adapted from CMHS Disaster and Crisis Mental
  Health Populations with Special Consideration
  presentation

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KEY CONCEPTS TO REMEMBER

• Strategize on how to access your populations with
  special considerations
• Invite the cultural broker of the community or
  each population with special considerations to
  participate in planning
• Be aware of gaps in intervention and service to
  populations with special considerations
• Adapted from CMHS Disaster and Crisis Mental
  Health Populations with Special Consideration
  presentation