1. Welcome “Bridging Behavioral Health and Spiritual Care For Disaster Victims”

2. “Bridging Behavioral Health and Spiritual Care For Disaster Victims” Edward Smith Deputy Executive Director Victim Relief Ministries Spiritual Bridge Connection Applications Focus on: Chance Freeman Branch Manager DSHS Disaster Behavioral Health Services

3. What do you expect to gain from this training?

4. The mission of the Disaster Behavioral Health Services (DBHS) is to lessen the adverse behavioral health effects of trauma for victims, survivors and responders of traumatic events, whether those events be natural or man-made. Mission Statement

5. Mission is accomplished through proactive behavioral health responses to catastrophic events by providing defusing, debriefings, crisis interventions, crisis counseling services, and referrals to additional resources.

6. DBHS has 6 basic program functions 1.Serve as the liaison to the Texas Division of Emergency Management and other federal resources on disaster mental health issues 2.Coordinate all DBH, CISM and Crisis Counseling services during a state or federally declared disaster 3.Provide brief crisis counseling services during state or federal critical incidents or disasters

7. 4.Develop and submit all State and FEMA grant applications on behalf of DSHS & the impacted communities. This includes Crisis Counseling and Public Assistance grants 5.Provide Educational, Advocacy & Stress Management Services 6.Assist in the development of internal emergency response abilities and resources and assist in the coordination of internal response and recovery activities from traumatic events. Program Functions continued

8. CISM: Primary Components Pre-event Planning / Education / Preparation Surveillance and Assessment Strategic Planning Individual Crisis Intervention Large Group Crisis Intervention: Demobilizations (large groups of rescue / recovery) Respite / Rehab Sectors Crisis Management Briefings (CMB)

9. CISM: Primary Components Small Group Crisis Intervention: Defusings CMB Critical Incident Stress Debriefing (CISD) Family CISM Organizational / Community intervention, consultation Pastoral crisis intervention Follow-up and referral for continued care

10. Cooperation is the Key

11. How Texas Administers the Program Disaster response and recovery efforts include partnerships between DSHS and the following: Texas Division of Emergency Management Federal Emergency Management Agency Center for Mental Health Services Substance Abuse and Mental Health Services Administration 37 Local Community Mental Health Centers 140 Contracted Substance abuse providers 24 Critical Incident Stress Management Network Teams Voluntary Organizations Active in Disaster Community stakeholders and gatekeepers

12. Disaster Behavioral Health Assistance Team (BHAT) Specialized team that provides coordination and delivery of DBH services during a large disaster Works closely with DSHS, State Medical Operations Center (SMOC), Local Mental Health Authority (LMHAs), Substance Abuse (SA) providers, TDEM, Mass Care, and Department of Public Safety (DPS) Liaison Officers

13. BHAT Responders Trained and certified across a broad spectrum licensed mental health professionals qualified mental health professionals trained para-professionals public health workers substance abuse treatment professionals Texas CISM Network Teams Spiritual Care Providers

14. BHAT Expectations Deployment within impacted region for up to 6 days 2 travel days 4 direct service days Provide early psychological intervention Gather and report encounter and financial data to DBHS each day

15. Preferred Training & Experience for BHAT Responders ICS (100, 200, 700) (Free on-line) Psychological First Aid, Mental Health First Aid, CISM, or some other Early Psychological Intervention Ability to travel and work under adverse conditions Experience working with survivors of disasters and/or critical incidents Specialized training: children and adolescents, cultural diversity, geriatric populations, victims of crime, grief and loss, special needs populations, death notifications, bilingual skills, etc.

16. Key Concepts of Disaster No one who sees a disaster is untouched by it Primary, secondary and tertiary victims Two types of trauma Individual (stress and grief reactions) Collective (Damages the bonds and social fabric of the community. Increases fatigue, irritability and family conflict.)

17. Dates Ingrained in our Memories November 22, 1963 April 19, 1995 September 11, 2001 February 1, 2003 August 28, 2005

18. Dates Ingrained in our Memories November 22, 1963 Assassination of President John F. Kennedy April 19, 1995 Oklahoma City Bombing September 11, 2001 911 – Attack on the World Trade Center February 1, 2003 Space Shuttle Columbia Explosion August 28, 2005 Hurricane Katrina impacts State of Louisiana

19. Crisis Counseling vs. Traditional Mental Health Traditional Primarily office-based Focuses on diagnosis and treatment of mental illness Attempts to impact personality and functioning Examines content Encourages insight into past experiences and influence on current problems Psychotherapeutic focus Crisis Counseling Primarily home and community-based Assessment of strengths, adaptation and coping skills Seeks to restore pre-disaster functioning Accepts content at face value Validates appropriateness of reactions and normalizes experience Psychoeducational focus

20. Disaster Behavioral Health Do the Programs Work? Mural projects used as part of the Crisis Counseling Program during Hurricane Ike in 2008

21. Disaster Behavioral Health Do the Programs Work? The purpose and scope of the program is to provide preventative services to survivors of disasters that are designed to help reduce the adverse effects of trauma & prolonged stress and reduce the development of more long-term mental illness.

22. What we ARE NOT, or at least SHOULD NOT be... We ARE NOT there to provide traditional therapy We are there to provide CRISIS counseling and BRIEF interventions and REFERRALS as appropriate and necessary. There ARE NO leather sofas, hand holding and/or praying to the disaster gods for relief.

23. What we ARE NOT, or at least SHOULD NOT be... We ARE NOT there to “look” for customers or consumers Our State and Community Center staff is there working under the same authority and conditions as are other state staff. Our services are free and NO ONE should be charged for services. NO ONE should be “hanging out their shingle”

24. What we ARE NOT, or at least SHOULD NOT be We ARE NOT there to make a diagnosis We ARE NOT there to determine that you, your staff and/or the disaster survivors are “CRAZY”, or “IN NEED OF THERAPY”. We are there to lend a listening ear, provide practical stress management education, and provide referrals and interventions only when necessary. We are there to help everyone, including “normal” people, experiencing normal trauma, recover from an abnormal event.

25. Special Populations Disaster Workers First Responders Children and Youth Older Adults People with Disabilities People with Serious Mental Illness Veterans People with Low Socioeconomic Status Cultural and Ethnic Groups

26. Crisis Intervention Promote safety and security Gently explore disaster experience Identify priority needs and solutions Assess functioning and coping Provide Reassurance Psychoeducation Practical assistance

27. Who’s There When the Police and Emergency Management Leaves? The haunting question…

28. Who’s There … From the faith community? From the mental health community? Who is there for the victim?

29. The Bible Mandate The Great Commandment “Love the Lord Your God with all Your Heart and with all Your Soul and with all Your Strength and with all Your Mind;” and “Love Your Neighbor as Yourself.” and “Love Your Neighbor as Yourself.” Luke 10:27

30. The Commitment to Love Paid for Lodging Spent Time with Victim Cared for Victim Obtained Shelter Provided Transportation Provided First Aid Responded to Victim Felt Compassion Promised to Return Committed To Pay Whatever More Needed Bible Mandate Good Samaritan Luke 10:30-35 Victim Relief

31. How does this apply in the “Definition” of Emotional and Spiritual Care? EMOTIONAL CARE- Addresses the need for those in crisis to express their fears, doubts and questions without judgment or interruption. It is about “telling their story” to someone trained to listen. IT IS THROUGH LISTENING- that VRM responders can tell if a person is better served by mental, physical or spiritual services and then serve as a facilitator to give them access to those needed services. SPIRITUAL CARE- is the vital connection that people need in coping with the events from their faith perspectives and how to draw from that strength, healing and hope- all vital components of going from victim to survivor as their recovery unfolds.

32. Emotional and Spiritual Care Providers serve initially as a calming presence At the place of impact and begin the process of “Building a Stabilizing Bridge” F rom all responding and supporting groups, elements and resources T o the victim who is suffering from trauma, grief and shock! And On to the process of being a survivor who is regaining Their ability to cope and deal with The tragedy and begin to move forward On the journey Of the reality of the “New Normal”

33. Connect to Emotional Care Mental Health Services/Partnership DHHS Crisis Intervention Debriefings Work in Coordination with DSHS- Disaster Behavioral Health Services

34. Connect to Spiritual Care (Qualifications) Chaplains are ordained ministers/Crisis Responders trained Trained and Certified thru minimum of 16 hour VRM Basic 2-Day course Advanced Trauma and Grief training under Dr. Norm Wright CISM Trained Psychological First Aid Grief and Trauma training Incident Command Training and Structure Licensed Professional Counselors “Ministry of Presence”

35. SEARCH AND RECOVERY

36. EVACUATIONS

37. SHELTERING

38. PODS- POINTS OF DISTRIBUTION

39. CRISIS INTERVENTION

40. FATALITIES MEMORIALS

41. CISM- DEBRIEFINGS

42. SPIRITUAL AND EMOTIONAL STATIONS

43. EMERGENCY ROOMS- UTMB

44. RE-ENTRY OF FAMILIES

45. FAC’s-FAMILY ASSISTANCE CENTERS

47. “Bridging Mental Health and Spiritual Care for Disaster Victims” “Spiritual Care is Faith in Action”

48. Stress is: Normal Necessary Productive and destructive Acute and delayed Cumulative Identifiable Preventable and manageable

49. Stress Management/Self-Care Staff: Incorporate coping skills into disaster recovery work and provide stress management training Talk to friends Take a walk Exercise

50. Resistance & Resilience Students identified a personal strength and created a symbol of their strength with modeling clay. The trophies were awarded during the final group session.

51. Resilience “From the children, I learned the true meaning of resiliency and the fact that resiliency can be cultivated.”

52. Contact Information Disaster Behavioral Health Services 909 West 45 th Street Austin, TX 78751-2008 (512) 206-5555 DBHS@dshs.state.tx.us http://www.dshs.state.tx.us/MHSA-Disaster/