The Basic Skills of Disaster Behavioral Health

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The Basic Skills of Disaster Behavioral Health

• TADBHAC Joint Partnership With VDH/DMHMRSAS

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Housekeeping

• Lunch plans
• Restrooms, exits
• Cell phones on vibrate, please exit the room to
  take calls
• Monitor your own stress level
• Materials
• You will have plenty of opportunities to be
  involved in the learning process with activities
  and practice exercises.
• Schedule for the day

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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

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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

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Introductions
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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
• CSBs have an all hazards behavioral health
  response plan
• Everyone is a resource

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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 respite sites

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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

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Stress and Disasters
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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

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NORMAL REACTIONS to an ABNORMAL EVENT.
Stress
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Signs of Stress Reaction

• Concentration problems
• Anxiety
• Identification with victims
• Flashbacks
• Difficulty sleeping
• Changes in eating habits
• Changes in working habits

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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.

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Stress Reactions to a Disaster
Indicates a flag for professional referral
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Factors Influencing The Emotional Impact Of A
Disaster

• Disaster individual/communit
  y 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

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Maslows Hierarchy of Needs
Self Actualization
Self Esteem
Social Affiliation
Personal Safety
Physiological Needs
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Phases of Recovery in a Disaster Situation

• Impact
• Heroic
• Honeymoon
• Inventory
• Disillusionment
• Reconstruction

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

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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.

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Basics of Psychological First Aid
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Psychological First Aid

• Protect
• Direct
• Connect

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Summary of Basic Principles of Psychological
First Aid
Protect Direct Connect

• Contact and engagement
• Safety and comfort
• Stabilization

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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

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Protect Direct Connect
Summary of Basic Principles of Psychological
First Aid

• Information gathering current need and concerns
• Practical assistance

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Protect Direct Connect
Summary of Basic Principles of Psychological
First Aid

• Connection with Social Supports
• Information on Coping
• Linkage with Collaborative Services

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Dos of Psychological First Aid
Offer respect. Politely observe first, dont
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 dont 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 persons
immediate goals and clarify answers repeatedly as
needed. Share helpful information. Give
information that is accurate and age-appropriate
for your audience. If you dont know, tell them
this and offer to find out.
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Donts of Psychological First Aid
Dont be a mind reader. Do not make assumptions
about what the survivor is thinking, feeling or
experiencing. Dont assume trauma. Do not take
for granted that everyone exposed to a disaster
will be traumatized. Dont pathologize. Do not
label anyone with symptoms or diagnoses.
Dont talk down to a survivor. Do not patronize
survivors, or focus on their helplessness,
weaknesses, mistakes, or disabilities. Dont
assume they need you. Do not think that all
survivors want or need to talk to you. Dont
debrief. Do not probe for painful or gory details
of what happened. Dont spread rumors. Do not
speculate or offer unsubstantiated information.
Dont be faddish. Do not suggest fad
interventions. Stay with the tried-and-true
basics of meeting immediate needs with respect
and sensitivity.
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Crisis Intervention
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Crisis
Distinct From Trauma Disorder Turning
Point Momentous Decision Danger and
Opportunity
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Goals of Crisis Intervention
Enhance Opportunities Stabilize Reduce
Dangers
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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 persons 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

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Basic Skills of Crisis Intervention

• Active listening
• Reflecting
• Normalizing
• Prioritizing
• Assessment
• Stress management
• Holding the bucket

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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?)

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Crisis Intervention Strategy IThe LUV Triangle
Reach Out With LUV
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Using the LUV Triangle
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LUV Triangle Listen

• Face and give the person your undivided
  attention.
• Lean toward the person and make eye contact.

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LUV Triangle Understand

• Repeat or paraphrase what the person is saying.
  
• Check your understanding.

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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

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LUV Triangle Validate

• Offer minimal encouragers, such as the lassie
  twist.
• Show your faith in the person by not giving
  glib advice.

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Activity 3 - Part 1

• Divide into pairs with someone you dont know
• 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.

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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?

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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?

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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?

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Crisis Intervention Strategy IIFinding the
Survivor Resiliency
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• 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?

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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 persons 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

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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

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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)

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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?

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Special Considerations
Elderly Persons with mental illness Children
Physically Challenged WorkforceCultural and
ethnic differences
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Are You Ready?Personal Preparedness As a
Responder
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Self Care As a Responder

• Be Prepared! Have an emergency kit
• Use the buddy system
• Take breaks Rotate shifts
• Monitor your own stress level

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Putting It All Together

• What does my local response plan look like?
• When do I provide Psychological First Aid?
• When do I provide crisis intervention?
• How do I interact with others who are also
  responding?
• How do I know what to do when I get there?
• Do I self-deploy?

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Conclusion

• Final Questions
• Please complete class evaluations
• Thank You for Coming!