The Basic Skills of Disaster Behavioral Health

The Basic Skills of Disaster Behavioral Health
Note to Faciilitator: Show Title Slide Make introductions individually if you can as learners enter the room TADBHAC Joint Partnership With VDH/DMHMRSAS

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 Note to Facilitator: - 2 minutes Review slide Make any additional housekeeping announcements needed, regional trainer at your site will have logistics announcements about lunch Review what materials they should have; a folder with Hand out of presentation Field guide for Helping to Heal Psychological First Aid manual Personal preparedness brochure Class evaluation They will receive certificate of completion at end of the day Emphasize the last bullet; Invite and encourage active participation; you may ask the audience at this point if you have anyone with actual field experience responding as a behavioral health practitioner, or as an actual emergency responder in their specialty area (police, fire, public health, etc..)

Identify range of responses to disasters
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 Note to Facilitator: - 3 minutes Review objectives slide with the class Say: At the end of the day what we want you to leave the room with is an understanding of the principles of disaster behavioral health and practice using some of the basic skills you would use as a paraprofessional in the field of mental health. Note to Facilitator: You will have a mix in the audience of mental health professionals and emergency responders. Address the terminology and use of paraprofessional if needed.

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 Note to Facilitator: - 3 minutes Review objectives slide with the class - continued

Introductions Note to Facilitator: Intros
Ask general audience questions about experience in disasters Who has been in a disaster? How will that help you today? How did you get through a disaster?

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 Facilitator Notes: 3 minutes Say: To begin with, all formal behavioral health responses will originate from a request from an Emergency operations center at a local level and will move forward from there. The range of disaster behavioral health services is vast and will depend on victim and community needs. Review slide bullets Discuss range of disaster mental health interventions and give an example if possible Rapid assessment and triage Crisis intervention Supportive listening Problem-solving immediate issues Education about disaster stress Debriefing and community meetings Information and referral References: H2-MODULES 3 AND 4 DESCRIBE CSB ROLES, PLANNING AND CRISIS COUNSELING PROGRAMS PAGES 40-79

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 2-3 minutes Note to Facilitator: Discuss what this level of training will enable audience to do; (examples under the first question) Lay the groundwork for the resiliency model here; why are these the services that are needed? Define the use of “paraprofessional” role in behavioral health interventions. Give examples of what a professional vs. paraprofessional would do. Transition Statement: Say: Now let’s discuss some key terms we will be using throughout the day. These key terms are important to understand as you are providing services. Reference Points: H2: PGS 166, 213 ATTRIBUTES OF DMH RESPONDERS PFA:PGS 40-41

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 Facilitator Notes: - 20 minutes Review these concepts; provide examples when able Check for understanding here; ask if there are questions about what has been covered up to this point. Reference Points: H2: PG 66 ALSO MODULE 7 PGS PFA: PG 4

Stress and Disasters Note to Facilitator:
Check for understanding at this point. Ask if participants have any questions about what was just covered before moving on. Introduce next section discussing stress and stress reactions in disasters

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 Read definition to participants Ask class: What is your reaction to that? Seem accurate? Any questions or comments it brings up for you?

NORMAL REACTIONS to an ABNORMAL EVENT.
Stress NORMAL REACTIONS to an ABNORMAL EVENT. Read slide Ask for examples of this statement

Signs of Stress Reaction
Concentration problems Anxiety Identification with victims Flashbacks Difficulty sleeping Changes in eating habits Changes in working habits Review slide with participants Reference Point: H2: pg 86

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…. Note to Facilitator: 5 minutes Discuss each of these bulleted concepts Good Stress/Bad Stress Good Stress – any stress event that increases performance and the ability to respond Bad Stress- Any stress event that overwhelms and decreases your ability to respond, leads to emotional upset or physical illness Internal/External stress Normal response to abnormal event – it is the event that is abnormal; not the response to the event Flight/Fight/Freeze Reaction – briefly discuss this concept Say: Now let’s look at the next slide for a test of your observational skills in identifying the subtle cues of stress. Look closely ….(humorous slide is next)

Note to Facilitator: Note: minutes for next 3 slides Ask: What signs of stress do you notice in this picture? Say: Now, the next picture will be of a real human being under stress.

Note to Facilitator: (Should see a picture of girl sliding down big slide) Point out the commonalities between the cat’s reactions and the girl’s. Some people seek out this kind of stress; Say: Now, the next picture will be of a real human being under distress. Ask: What signs of distress do you notice in this next picture.

Facilitator Notes: (Should be picture of boy after a major tornado has destroyed his home) Say: Now, we have a picture of a real child in a real disaster situation. Ask: What signs of distress do you see here? What are your own reactions to seeing this child? What would you like to do for him?

Stress Reactions to a Disaster
Emotional Effects Cognitive Effects Shock Anger Despair Emotional numbing Terror Guilt Grief or sadness Irritability Helplessness Loss of derived pleasure from regular activities Dissociation (e.g., perceptual experience seems “dreamlike,” “tunnel vision,” “spacey,” or on “automatic pilot”) * Impaired concentration Impaired decision-making ability Memory impairment Disbelief Confusion Distortion * Decreased self-esteem Decreased self-efficacy Self-blame Intrusive thoughts and memories Worry Physical Effects Interpersonal Effects Fatigue Insomnia Sleep disturbance Hyperarousal Somatic complaints Impaired immune response Headaches Gastrointestinal problems Decreased appetite Startle response Alienation Social withdrawal Increased conflict within relationships Vocational impairment School impairment Desire for retaliation * Scapegoating Note to Facilitator: 2-3 minutes Review some highlights of this chart; give examples Say: This chart gives a list of some of the different types of stress reactions you may see in people following a disaster. Ask: Did anyone experience any of these in your own descriptions during the introductions activity? Which ones are normal? Which one of the reactions are the ones that would indicate a need for futher evaluation for a referral to professional services? Reference Points: H2: PG 86 * Indicates a flag for professional referral

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 Note to facilitator: 2-3 minutes Discuss slide Refer back to the original stories during introduction activity Refer to reference page giving definitions at the back of the ppt presentation

Maslow’s Hierarchy of Needs
Self Actualization Self Esteem Social Affiliation Facilitator Note: minutes Discuss Slide Make transition to psychological first aid and this slide as one way of conceptualizing people’s needs during a disaster; at what level does a disaster affect getting one’s needs met Ask: If a disaster attacks physiologic needs what would your responses and interventions be when providing services? Say: If you respond to their physiologic needs you are helping to restore world view that people care about them; they are significant; basics of psychological first aid; This applies to everyone; “we are all a bunch of triangles walking around” Expect resilience and normal recovery; provide the right support Personal Safety Physiological Needs

Phases of Recovery in a Disaster Situation
Impact Heroic Honeymoon Inventory Disillusionment Reconstruction Facilitator Note: 3 minutes H2 PGS Discuss slide Personal and community level of recovery facilitate this discussion Caution around use of phases and movement through; can change based on levels or facets of disasters (economic, etc…) Make sure to mention a focus on the immediate response should be in place

Assignment Think about advice or support you received during the disaster you described in the introduction. What was helpful? What would have helped? Facilitator Note: It should be about time for a break at this point; either break for lunch or give 10 minute bio break

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. Complete activity as described above – 20 minutes

Basics of Psychological First Aid
Facilitator Note: When returning from break; take responses from the group about the question asked prior to the break Make transition to next topic area: Say: Now we are going to move into our behavioral health response to disasters. Providing psychological first aid. First let’s look at what that means.

Psychological First Aid
Protect Direct Connect Facilitator Notes: 2 minutes Review the 3 concepts of psychological first aid; the text below is a guide Survivors need to be protected from viewing traumatic stimuli from the event. In addition, they need to be protected from curious onlookers and the media. When disoriented or in shock, survivors need to be directed away from trauma scene and danger, and into a safe and protected environment. A brief human connection with a disaster mental health worker can help to orient and calm them. Disaster mental health workers assist survivors by connecting them with loved ones, as well as with needed information and resources. Reference Point: H2: PG PFA: PGS 4-10

Summary of Basic Principles of Psychological First Aid:
Protect + Direct + Connect Contact and engagement Safety and comfort Stabilization Facilitator Note: 10 minutes for the next two slides Review slide Make some comparisons – where does this apply in the Maslow chart and the immediate phase of dealing with a disaster Ask: What items do you see here that we discussed earlier today? Safety and security needs….up the chart Reference Point: PFA PGS 11-19

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 Activity 2: 15 minutes Scenario examples Hospital parking lot Recovery scene of a tornado; parking lot in school filled with parents; provide psychological first aid What would you find yourself doing? (provide safety and comfort)

Protect + Direct + Connect
Summary of Basic Principles of Psychological First Aid: Protect + Direct + Connect Information gathering: current need and concerns Practical assistance Review Slide Reference Point: PFA : PGS 20-25

Protect + Direct + Connect
Summary of Basic Principles of Psychological First Aid: Protect + Direct + Connect Connection with Social Supports Information on Coping Linkage with Collaborative Services Review Slide Reference Point: PFA: PGS 26-39

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. Facilitator Note: 15 minutes for the next two slides Review bullets, give examples when able Ask: What items do you see here that we discussed earlier today? Safety and security needs….up the chart Reference Point: H2: PGS PFA: PG 6

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. Facilitator Note: Review some of the things to avoid saying Ask: Any “don’ts” surprise anyone? Reference Points: PFA: PG 7; PG 54 DEATH; H2: CULTURAL COMPETENCE

Crisis Intervention Facilitator Notes: 5 minutes
Discuss how crisis intervention is different from psychological first aid. Use the points below as a guide if needed While crisis intervention is somewhat similar to psychological first aid, it goes beyond the first stages of the disaster to: Assist survivors to regain some sense of control and mastery over life Reestablish rational problem-solving abilities An underlying assumption is that the survivor’s distress and coping difficulties are due nature of the event. 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 (Helping to Heal manual) Ask: How many of you have teenagers? Say: You may find that this is helpful with teenagers; this can be used more than just in a disaster situation Reference Point: H2: PG

Crisis • Distinct From Trauma & Disorder • Turning Point
• Momentous Decision • Danger and Opportunity Facilitator Note: 5 minutes Review the slide making the following points: It can occur in response to trauma and disorder; Is usually a pivotal point for a person Can be a joyful or traumatic experience Trauma is from the Greek for “wound”. Therefore, a psychological trauma is when the mind has been wounded or damaged. Disorder is a disease. Crisis comes from the Greek for “decision” Say: The next slide shows the Chinese symbol for crisis is the combination of both danger and opportunity.

Facilitator Note: 1 minute
Should see picture of Chinese symbol of crisis Danger and opportunity

Facilitator Note: 1 minute for next two slides
(should see picture of cat with fly on it’s nose) Say: It’s all in how you look at things. We need to focus on the opportunity as we face the danger.

Facilitator Note: (briefly show this slide; should see picture of Buddha and baby) Say: If we look for them, we can find hidden commonalities and patterns.

Goals of Crisis Intervention
Enhance Opportunities Stabilize Reduce Dangers Facilitator Note: 2 minutes Relate this back to the protect, direct, connect and the slide for Chinese symbol of crisis These are the same goals as psychological first aid Example: person who is involved in AA and stayed sober; they are involved in a disaster situation; this is an opportunity for great danger and opportunity

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 Note to Facilitator: 5 minutes Talk through the process of a crisis intervention Give examples Reference Point: H2 PG THIS IS THE REVISED EDITION!

Discuss chart of movement from victim to survivor to thriver

Basic Skills of Crisis Intervention
Active listening Reflecting Normalizing Prioritizing Assessment Stress management Holding the bucket Note to Facilitator: 10 minutes Reference Point: PFA: ASSESSMENT 20-24 Review slide using the text below as a guide as needed; demonstrating with examples when able Tips for good active listening: Paraphrase—Rephrasing portions of what the survivor has said conveys understanding, interest, and empathy. Paraphrasing also checks for accuracy, clarifies misunderstandings, and lets the survivor know that he or she is being heard. Good lead-ins are: “So you are saying that . . .” or “I have heard you say that . . .” Reflect feelings—The paraprofessional may notice that the survivor’s tone of voice or nonverbal gestures suggests anger, sadness, or fear. Possible responses are, “You sound angry, scared, etc.; does that fit for you?” This helps the survivor identify and articulate his or her emotions. Allow expression of emotions—Expressing intense emotions through tears or angry venting is an important part of healing; it often helps the survivor work through feelings so that he or she can better engage in constructive problem-solving. The paraprofessional helps by remaining relaxed and letting the survivor know that it is okay to feel that way. Use nonverbal cues—The paraprofessional can use facial expressions (e.g., smiling at appropriate times), eye contact, open body language, and head nodding to show survivors that he or she is listening Allow for silence, if appropriate—Silence gives the survivor time to reflect and become aware of feelings and can prompt the survivor to elaborate.

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?) Facilitator Note: 5 minutes Review bullet points Discuss what we mean by “holding the bucket’

Crisis Intervention Strategy I The LUV Triangle: Reach Out With LUV
Note to Facilitator: Check for understanding; ask if there are questions about anything that has been covered so far. You may need to take a break here

Using the LUV Triangle Note to Facilitator:
This section introducing the LUV triangle should take about 20 minutes for next 6 slides Introduce this LUV model as any easy way to remember how to respond Comment on this as the empathic connection

LUV Triangle: Listen • Face and give the person your undivided attention. • Lean toward the person and make eye contact. Facilitator Note: Review slide making the following point The art of listening has three parts: Listening to and understanding nonverbal behavior Listening to and understanding verbal messages Listening to and understanding the person

LUV Triangle: Understand
• Repeat or paraphrase what the person is saying. • Check your understanding. Facilitator Note: Discuss examples of paraphrasing and checking your understanding Ask the participants to give examples from their own work and personal lives

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 …… Facilitator Note: Discuss understanding and responding using the notes below as needed Paraphrase—Rephrasing portions of what the survivor has said conveys understanding, interest, and empathy. Paraphrasing also checks for accuracy, clarifies misunderstandings, and lets the survivor know that he or she is being heard. Good lead-ins are: “So you are saying that . . .” or “I have heard you say that . . .” Reflect feelings—The paraprofessional may notice that the survivor’s tone of voice or nonverbal gestures suggests anger, sadness, or fear. Possible responses are, “You sound angry, scared, etc.; does that fit for you?” This helps the survivor identify and articulate his or her emotions. Allow expression of emotions—Expressing intense emotions through tears or angry venting is an important part of healing; it often helps the survivor work through feelings so that he or she can better engage in constructive problem-solving. The paraprofessional helps by remaining relaxed and letting the survivor know that it is okay to feel that way. Use nonverbal cues—The paraprofessional can use facial expressions (e.g., smiling at appropriate times), eye contact, open body language, and head nodding to show survivors that he or she is listening Allow for silence, if appropriate—Silence gives the survivor time to reflect and become aware of feelings and can prompt the survivor to elaborate. Some survivors will not feel like talking much. Simply “being with” the survivor can be supportive

Facilitator Note: Comment on physical communication of connection Say: This is a photo of a counselor with survivors of the tsunami in Sri Lanka. Notice how this person leans in, focuses her attention, and engages with this child.

LUV Triangle: Validate
• Offer minimal encouragers, such as the “lassie twist.” • Show your faith in the person by not giving glib advice. Facilitator Note: Discuss what it means to validate – to honor them as coping individuals; assuming resilience Give examples of responses; ask participants for examples Say: Since the survivor will be doing the vast majority of talking, the Lassie Twist is a nonverbal communication you can use to express a variety of messages, without interrupting the flow of the survivor’s story. With a slight tilt of the head, you may communicate a sense of curiosity. Adding an expression of concern to the tilt can communicate compassion. Never offer trite expressions and empty reassurances, such as “Every cloud has a silver lining,” or “You can rebuild your home so it’ll be better than before,” or “Your baby is now happy in Heaven.” Say: Encourage them to beware of joining in the anger and bash agencies; instead join with them to empower them; join with the survivor not the victim!

Activity 3 - Part 1 Divide into pairs with someone you don’t 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. Facilitator Note: 20 minutes timeframe for Activity 3, Part 1 activity; including review Review directions with group verbally – you will need to read them and repeat the directions Show next slide to review the activity

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? Facilitator Note: Debrief activity When participants are providing feedback on experiences; Add in nuance of identifying strengths and finding the survivor

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? Facilitator Note: 20 minutes timeframe for Part 2 activity; including review Review directions with group verbally – you will need to read them and repeat the directions Prepare class that this activity is emotionally loaded; groups frequently cry; and that is okay; Give participants the tip from D.M.: How to stop the crying: wiggle the toes on one side and the fingers on the other side; Again offer up if activity is too much for someone; they can opt out

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? Facilitator Note: When participants are providing feedback on experiences; again, add in nuance of identifying strengths and finding the survivor Ask audience why this exercise is important; Be sure to give enough time to debrief this activity Take another break here; 5 minutes

Crisis Intervention Strategy II Finding the Survivor: Resiliency
Facilitator Note: Ask for any comments/questions from what was just covered Introduce the next section on finding the survivor and promoting resiliency

Facilitator Note: Ask: Ask participants if they can find the survivor in the victim in above picture: Say: The word survivor is vertically displayed in the “T” of victim Embedded within the victim is the survivor; it is our job to help them find the survivor; We aren’t talking only about the direct victims but also talking about the co-workers; families;

Facilitator Note: This should be picture of house devastated by Katrina Comment on the resiliency message here; Ask participants if there were messages of resiliency in introduction activity from this morning; did they get any help from others finding their own resiliency in dealing with their disaster?

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?” Facilitator Note: Discuss questions that help presume competence and resilience; broaden victim story to one of survival; the text below is a guide One way that the paraprofessional can be very helpful to the survivor of terrorism is by helping the person find solutions to practical problems. It is important to help the survivor recognize his or her own strengths so that he or she can successfully recover from the event. Ask audience to brainstorm additional questions to ask: write them on a flipchart Below are examples of open-ended questions that help explore problem-solving strategies. What ideas have you already considered? Can you tell me what you have already done about that situation? How did you handle similar situations in the past? What part of the problem is something you have control over? Reference Point: H2: PGS RESILIENCEY

Facilitator Note; This picture is Portraying their survival and getting back together with friends This is after Katrina in Mississippi

Facilitator Note: Pascagoola Mississippi; a survivors journal of how she and her family were surviving after Hurricane Katrina All are pictures emphasizing resilience and survival

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 Facilitator Note: REPEAT OF SLIDE 33 This is a review slide of the steps of crisis intervention review with participants Reference Point: H2: PG

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 Facilitator Notes: 15 minutes At least one of the pair practice providing crisis intervention Disaster behavioral health support woman sitting alone in her 30’s assume her child is affected by disaster; move from providing psychological first aid to providing crisis intervention; person who is victim should show symptoms of needing referral What are you doing different in crisis intervention; go through the steps finding strengths, etc….

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) Facilitator Notes: minutes Review slide bullets Be clear about the role of a paraprofessional and the importance of linking survivors to community resources and providing support. Be aware of confidentiality issues and follow team guidelines. Talk with survivors about their feelings without analyzing their reactions. Know how to identify more problematic reactions and when to refer for a more comprehensive assessment Reference Point: H2 PG 97

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? Facilitator Note: 10 minutes Complete this activity as a large group Review the scenario and discuss questions as a group Be sure discussion includes: Critical components in the scenario How to and who is the MH professional in the area to be contacted Role of the paraprofessional to be an expansion of the eyes and ears of MH

Special Considerations
Elderly Persons with mental illness Children Physically Challenged Workforce Cultural and ethnic differences Facilitator Notes: 3 minutes Ask: What might special considerations be for these groups? Emphasize that being a member of these groups doesn’t mean they are higher at risk; just be aware of what accommodations might need to be made Discuss with Class: Example – member of mental retardation community; relive disaster by watching TV Delayed reactions Example – do you have to be present to be affected by disaster? Ask for final questions on this topic Reference Points: H2: ; ; ; ; KIDS ELDERS ; DEATH PFA: DEATH; KIDS

Are You Ready? Personal Preparedness As a Responder
Facilitator Note: Introduce that in order to be an effective responder you have to be prepared Point out personal preparedness materials in their packets

Self Care As a Responder
Be Prepared! Have an emergency kit Use the buddy system Take breaks; Rotate shifts Monitor your own stress level Facilitator Note: 5 minutes Discuss bullet points on slide using text below as a guide Self-care is critical. Before paraprofessionals can take care of others, they need to care for themselves by focusing on personal unique strengths in listening to survivors, giving survivors information about resources, and connecting survivors with needed assistance. Will encounter situations over which they will have no control and problems they will not be able to solve Can still strive to provide the best possible services within the limitations of the situation at hand The following are ways to maintain emotional and physical health: Limiting the amount of time spent watching television coverage of the terrorist event Staying physically healthy—exercising, eating right, and getting rest Sticking to routines as much as possible Stress at the event site can be relieved by: Taking breaks or going for walks Rotating shifts with coworkers Talking with a supervisor or other team members about the challenges of disaster counseling Reference Points: H2:

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? Facilitator Note: This is a summary slide to review what you have covered during the day. Talking Points: Review what your local organization picture looks like. How would an effort be organized within your agency, within your local community?

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

The Basic Skills of Disaster Behavioral Health

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The Basic Skills of Disaster Behavioral Health

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