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Texas Department of State Health Services Disaster Behavioral Health Services Joy Counce 1 Disaster Behavioral Health.

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Presentation on theme: "Texas Department of State Health Services Disaster Behavioral Health Services Joy Counce 1 Disaster Behavioral Health."— Presentation transcript:

1 Texas Department of State Health Services Disaster Behavioral Health Services Joy Counce 1 Disaster Behavioral Health

2 What do you expect to learn from this training? 2

3 Training Objectives After this training you will be able to: Define Disaster Behavioral Health (DBH) and list the 8 key concepts of DBHDefine Disaster Behavioral Health (DBH) and list the 8 key concepts of DBH Identify 6 Psychological Phases of DisasterIdentify 6 Psychological Phases of Disaster Identify 6 Stressors of Crisis Response WorkersIdentify 6 Stressors of Crisis Response Workers Identify 10 ways to manage stress during and after a disasterIdentify 10 ways to manage stress during and after a disaster 3

4 Definition of Disaster (1) A disaster is a natural or human-caused occurrence (e.g., hurricane, tornado, flood, tsunami, earthquake, explosion, hazardous materials accident, mass criminal victimization incident, war, transportation accident, fire, terrorist attack, famine, epidemic) that causes human suffering. A disaster is a natural or human-caused occurrence (e.g., hurricane, tornado, flood, tsunami, earthquake, explosion, hazardous materials accident, mass criminal victimization incident, war, transportation accident, fire, terrorist attack, famine, epidemic) that causes human suffering. A disaster creates a collective need that overwhelms local resources and requires additional assistance. Adapted from the Center for Mental Health Services (CMHS)

5 Definition of Disaster (2) A disaster is any natural catastrophe (e.g., tornado, hurricane, storm, high water, wind-driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, drought) or, regardless of cause, any fire, flood, or explosion in any part of the United States that in the determination of the President causes sufficient severity and magnitude to warrant major disaster assistance under the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1974 (Stafford Act). Robert T. Stafford Disaster Relief and Emergency Assistance Act (1974). 5

6 6 Characteristics and Repercussions of a Disaster Natural vs. Human Caused NaturalHuman Caused Earthquakes, fires, hurricanes, floods, tornadoes Airplane crashes, chemical leaks, mass violence, terrorism No one to blamePeople, governments, or businesses to blame Beyond human controlSeen as preventable and a betrayal by fellow humans Advance warning is possibleNo advance warning Post-disaster distress is high and felt mainly by survivors Post-disaster stress is often higher than that of natural disasters and felt by more people not directly affected

7 In September 2008, Hurricane Ike, covering over half of Cuba, makes its way west to Texas (NASA Satellite) 7

8 Definition of Disaster Behavioral Health (DBH) Disaster behavioral health is the provision of mental health, substance abuse, and stress management to disaster survivors and responders.Disaster behavioral health is the provision of mental health, substance abuse, and stress management to disaster survivors and responders. U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and ResponseU.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response 8

9 What is DBH? Disaster behavioral health is a departure from traditional behavioral health practice in many ways.Disaster behavioral health is a departure from traditional behavioral health practice in many ways. Disaster behavioral health interventions are designed to address incident specific stress reactions, rather than ongoing or developmental behavioral health needs.Disaster behavioral health interventions are designed to address incident specific stress reactions, rather than ongoing or developmental behavioral health needs. 9

10 What is DBH? (cont.) Outreach and crisis counseling activities are the core of disaster behavioral health services.Outreach and crisis counseling activities are the core of disaster behavioral health services. Behavioral health professionals work hand- in-hand with paraprofessionals, volunteers, community leaders, and survivors of the disaster in ways that may differ from their formal clinical training.Behavioral health professionals work hand- in-hand with paraprofessionals, volunteers, community leaders, and survivors of the disaster in ways that may differ from their formal clinical training. 10

11 What is DBH? (cont.) The primary goal is to decrease the stress of an event and mitigate future problemsThe primary goal is to decrease the stress of an event and mitigate future problems Modalities may include Psychological First Aid, Spiritual Care, Substance Abuse services, Critical Incident Stress Management (CISM), Crisis Counseling, or other crisis intervention and disaster specific support servicesModalities may include Psychological First Aid, Spiritual Care, Substance Abuse services, Critical Incident Stress Management (CISM), Crisis Counseling, or other crisis intervention and disaster specific support services 11

12 What is DBH? (cont.) Community basedCommunity based Focus on strengths & coping skillsFocus on strengths & coping skills Restore functioningRestore functioning Confirms reactions are common/normalConfirms reactions are common/normal Focus is educationalFocus is educational 12

13 Concepts of Disaster Behavioral Health Adapted from: DeWolfe, D. Field Manual for Mental Health and Human Service Workers in Major Disasters. DHHS Publication No. ADM , Washington, D.C.: U.S. Government Printing Office. Concepts of Disaster Behavioral Health Adapted from: DeWolfe, D. Field Manual for Mental Health and Human Service Workers in Major Disasters. DHHS Publication No. ADM , Washington, D.C.: U.S. Government Printing Office. 1. No one who sees a disaster is untouched by it 2.There are 2 types of disaster trauma – individual and community 3.Most people pull together and function after a disaster but their effectiveness is diminished 4.Stress and grief are common reactions to an abnormal situation 13

14 Concepts of Disaster Behavioral Health 5.Reactions often relate to survival and recovery issues 6.People do not seek out mental health services 7.Survivors may reject disaster assistance of all types 8.Mental health assistance is often more practical than psychological in nature 14

15 Preferred training/experience for disaster behavioral health responders 15

16 Preferred training/experience ICS (100, 200, 700, 800) (Free on-line through FEMA)ICS (100, 200, 700, 800) (Free on-line through FEMA) Psychological First Aid, Crisis Intervention, Pastoral Counseling, CISM, or some other Early Psychological InterventionPsychological First Aid, Crisis Intervention, Pastoral Counseling, CISM, or some other Early Psychological Intervention Ability to travel and work under adverse conditionsAbility to travel and work under adverse conditions Experience working with survivors of disasters and/or critical incidents or eventsExperience working with survivors of disasters and/or critical incidents or events Specialized training: children and adolescents, cultural diversity, geriatric populations, victims of crime, grief and loss, special needs populations, death notifications, etc.Specialized training: children and adolescents, cultural diversity, geriatric populations, victims of crime, grief and loss, special needs populations, death notifications, etc. 16

17 Possible DBH Outreach Locations Disaster Recovery Center (DRC)Disaster Recovery Center (DRC) Incident Command Post (ICP)Incident Command Post (ICP) Points of Distribution (POD)Points of Distribution (POD) Mass Care ShelterMass Care Shelter Joint Field Office (JFO)Joint Field Office (JFO) Disaster District Committee (DDC)Disaster District Committee (DDC) Regional Medical Operations Center (RMOC)Regional Medical Operations Center (RMOC) Family Assistance Center (FAC)Family Assistance Center (FAC) 17

18 Phases of Disaster 18

19 Phases of Disaster Emotional Highs 19 1 to 3 Days TIME to 3 Years Warning Threat Pre-disaster “Heroic” Honeymoon (Community Cohesion) (Coming to Terms) Working Through Grief Reconstruction A New Beginning Disillusionment Trigger Events and Anniversary Reactions Impact Inventory Zunin/Meyers

20 6 Psychological Phases of Disaster Pre-disaster PhasePre-disaster Phase Impact PhaseImpact Phase Heroic PhaseHeroic Phase Honeymoon PhaseHoneymoon Phase Disillusionment PhaseDisillusionment Phase Reconstruction PhaseReconstruction Phase 20

21 Pre-Disaster Phase Disasters with no warning Feelings of vulnerabilityFeelings of vulnerability Lack of securityLack of security Fears about the futureFears about the future Loss of controlLoss of control Inability to protect self and familyInability to protect self and family Disasters with warning Guilt and self-blame for failure to heed warningGuilt and self-blame for failure to heed warning 21

22 22

23 Impact Phase Usually the shortest phase Reactions vary dependent on length and type of disaster Range of intense emotional reactions from shock to overt panicRange of intense emotional reactions from shock to overt panic Fear and isolationFear and isolation AnxietyAnxiety Stunned and disorganizedStunned and disorganized Confusion and disbeliefConfusion and disbelief Self preservationSelf preservation 23

24 Impact Phase Needs Explanation of incidentExplanation of incident Safety/securitySafety/security Basic physical needs (Maslow’s Hierarchy of Need)Basic physical needs (Maslow’s Hierarchy of Need) Support/caringSupport/caring 24

25 25

26 Inventory Immediate assessment of damageImmediate assessment of damage Overwhelmed by disasterOverwhelmed by disaster Attempt to locate and assist survivorsAttempt to locate and assist survivors Initial discovery of non-survivorsInitial discovery of non-survivors Inability to locate loved onesInability to locate loved ones High need for informationHigh need for information 26

27 Heroic Phase Evacuation and relocation has psychological significanceEvacuation and relocation has psychological significance Family separationFamily separation High level of activity with low level of productivityHigh level of activity with low level of productivity Adrenaline-induced rescue behaviorAdrenaline-induced rescue behavior Risk assessment may be impairedRisk assessment may be impaired 27

28 28

29 Honeymoon Phase Usually only lasts a few weeks Disaster assistance readily availableDisaster assistance readily available Community bonding occursCommunity bonding occurs Optimism existsOptimism exists Opportunity to build rapport and relationships between providers, resources, affected people, and stakeholdersOpportunity to build rapport and relationships between providers, resources, affected people, and stakeholders 29

30 Disillusionment Phase Stress and fatigue take a tollStress and fatigue take a toll Optimism turns to discouragementOptimism turns to discouragement May have an increased need for substance abuse servicesMay have an increased need for substance abuse services Larger community returns to business as usualLarger community returns to business as usual Reality of losses sets inReality of losses sets in Diminishing assistance leads to feelings of abandonmentDiminishing assistance leads to feelings of abandonment 30

31 Reconstruction Phase Long-term process of rebuilding (1-3 years)Long-term process of rebuilding (1-3 years) Ongoing struggles with agenciesOngoing struggles with agencies Stress of temporary housing/financesStress of temporary housing/finances Requires committed community supportRequires committed community support Adjustment to new circumstances/the new normal while possibly still grievingAdjustment to new circumstances/the new normal while possibly still grieving Good news: most people rebuild and discover new meaningGood news: most people rebuild and discover new meaning 31

32 Psychological Consequences of a Disaster 32 From IOM publication “Preparing for the Psychological Consequences of Terrorism” NOTE: Indicative only; not to scale Distress Responses

33 Typical Individual Outcome of Disaster Most will return to normal function with no significant problemsMost will return to normal function with no significant problems Some will have severe reactionsSome will have severe reactions Few will develop diagnosable conditionsFew will develop diagnosable conditions Most do not seek help or treatmentMost do not seek help or treatment Survivors often reject helpSurvivors often reject help 33

34 Common Reactions to a Disaster Trouble concentrating Trouble concentrating Difficulty making decisions Difficulty making decisions Preoccupation with the disaster Preoccupation with the disaster Frequent dreams or nightmares Frequent dreams or nightmares Increased alcohol/drug use Increased alcohol/drug use Feeling depressed, sad, irritable or angry Feeling depressed, sad, irritable or angry Tiredness or low energy for no reason Tiredness or low energy for no reason Increase or decrease in appetite Increase or decrease in appetite 34

35 Disorders that may result from severe reactions Depressive disordersDepressive disorders Social isolationSocial isolation Anxiety disordersAnxiety disorders Substance AbuseSubstance Abuse Posttraumatic Stress Disorder (PTSD)Posttraumatic Stress Disorder (PTSD) Suicidal ideation and behaviorSuicidal ideation and behavior ParanoiaParanoia 35

36 It is likely that early psychological intervention (i.e., response oriented crisis and disaster mental health intervention) is best thought of as a means of enhancing resiliency. [Kaminsky, et al, (2005) RESISTANCE, RESILIENCE, RECOVERY. In Everly & Parker, Mental Health Aspects of Disaster: Public Health Preparedness and Response. Balto: Johns Hopkins Center for Public Health Preparedness. 36

37 ALL Crisis Intervention should be based upon the Assessment of NEED…and the further ASSESSMENT of the most appropriate intervention. 37

38 Helpful guidelines… Never presume to know what the person is experiencing.Never presume to know what the person is experiencing. Do NOT assume that everyone is traumatized.Do NOT assume that everyone is traumatized. Do NOT label/diagnose or patronize.Do NOT label/diagnose or patronize. Do NOT “debrief”.Do NOT “debrief”. DO refer to professional help if out of your comfort zone or beyond your skill level.DO refer to professional help if out of your comfort zone or beyond your skill level. 38

39 Goals of DBH and early psychological interventions To help survivors:To help survivors: Understand their situations and reactionsUnderstand their situations and reactions Regain a sense of mastery and controlRegain a sense of mastery and control Identify, label, and express emotionsIdentify, label, and express emotions Adjust to the disaster and lossesAdjust to the disaster and losses Manage stressManage stress Make decisions and take actionMake decisions and take action Develop coping strategiesDevelop coping strategies Use community resourcesUse community resources 39

40 Characteristics of Early Psychological Interventions 40

41 Crisis Counseling EngageEngage Identify immediate needsIdentify immediate needs Gather informationGather information Prioritize needsPrioritize needs Provide practical assistanceProvide practical assistance EducateEducate Provide emotional supportProvide emotional support Determine next steps and follow upDetermine next steps and follow up 41

42 Psychological First Aid Core Actions Contact and engagementContact and engagement Safety and comfortSafety and comfort StabilizationStabilization Information gathering: currents needs and concernsInformation gathering: currents needs and concerns Practical assistancePractical assistance Connection with social supportsConnection with social supports Information for copingInformation for coping Linkage with collaborative servicesLinkage with collaborative services 42

43 Critical Incident Stress Management (CISM) icisf.org A comprehensive, integrative, multicomponent crisis intervention system that functionally spans the entire temporal spectrum of a crisis…pre- crisis, into acute crisis, and into the post-crisis phase.A comprehensive, integrative, multicomponent crisis intervention system that functionally spans the entire temporal spectrum of a crisis…pre- crisis, into acute crisis, and into the post-crisis phase. May be applied to individuals, small groups, large groups, families, organizations, and even communities.May be applied to individuals, small groups, large groups, families, organizations, and even communities. Founded in the emergency services professions in the late 1970sFounded in the emergency services professions in the late 1970s 43

44 Spiritual Care source: Nebraska Disaster Chaplain Network Disaster Spiritual Care: Devoting presence, attention, and respectful assistance to helping people discern what is the meaning in their lives now, in this new environment of destruction and pain; and how they will seek to live out that meaning as the recovery unfolds. Disaster Spiritual Care: Devoting presence, attention, and respectful assistance to helping people discern what is the meaning in their lives now, in this new environment of destruction and pain; and how they will seek to live out that meaning as the recovery unfolds. Foster McCurley, 2003Foster McCurley,

45 Ethics (FEMA Crisis Counseling Assistance and Training Program Participant Workbook: Module 1: Core Content Training, SAMHSA DTAC) Maintain confidentialityMaintain confidentiality Get a release of information before sharing any informationGet a release of information before sharing any information Follow the state and local regulations on mandatory reporting for child and elder abuse and neglectFollow the state and local regulations on mandatory reporting for child and elder abuse and neglect Follow state and local reporting regulations in cases of suicidal or homicidal intentFollow state and local reporting regulations in cases of suicidal or homicidal intent Safeguard the interests and rights of individuals who lack decision making abilitiesSafeguard the interests and rights of individuals who lack decision making abilities 45

46 Ethics (cont.) Ethical GuidelinesEthical Guidelines Do no harmDo no harm Participation is voluntaryParticipation is voluntary Consider reactions in relation to the disaster phase and contextConsider reactions in relation to the disaster phase and context Individual coping styles should be respectedIndividual coping styles should be respected Immediate interventions are supportiveImmediate interventions are supportive 46

47 Ethics (cont.) Talking with a person in crisis does not always mean talking about the crisisTalking with a person in crisis does not always mean talking about the crisis Be aware of the situational and cultural contexts of the survivor and the intervention itselfBe aware of the situational and cultural contexts of the survivor and the intervention itself 47

48 Typical Stressors for Crisis Counselors Working a Disaster Repeated exposure to traumatic storiesRepeated exposure to traumatic stories Exposure to survivors’ reactions to disasterExposure to survivors’ reactions to disaster Approaching survivors who may reject their helpApproaching survivors who may reject their help Feeling overwhelmed by the sadness of othersFeeling overwhelmed by the sadness of others Feeling helpless to alleviate the pain of othersFeeling helpless to alleviate the pain of others 48

49 Typical Stressors for Crisis Counselors Working a Disaster Staff shortagesStaff shortages Working long hoursWorking long hours Away from family and friends for extended periods of timeAway from family and friends for extended periods of time Personal experience with the disasterPersonal experience with the disaster 49

50 Signs That You May Need Stress Management Assistance Disorientation or confusion and difficulty communicating thoughtsDisorientation or confusion and difficulty communicating thoughts Difficulty remembering instructionsDifficulty remembering instructions Difficulty maintaining balanceDifficulty maintaining balance Becoming easily frustrated and being uncharacteristically argumentativeBecoming easily frustrated and being uncharacteristically argumentative Inability to engage in problem-solving and difficulty making decisionsInability to engage in problem-solving and difficulty making decisions 50

51 Signs That You May Need Stress Management Assistance Limited attention span and difficulty concentratingLimited attention span and difficulty concentrating Colds or flu-like symptomsColds or flu-like symptoms Headaches/tremors/nauseaHeadaches/tremors/nausea Loss of objectivityLoss of objectivity 51

52 Ways to Manage Your Stress Drink plenty of water, and eat healthy snacks like fresh fruit, whole grain breads, and other energy foods.Drink plenty of water, and eat healthy snacks like fresh fruit, whole grain breads, and other energy foods. Stay in touch with your family and friends.Stay in touch with your family and friends. Pair up with another responder so that you may monitor one another’s stress.Pair up with another responder so that you may monitor one another’s stress. Take frequent breaks as is practical.Take frequent breaks as is practical. Do not over identify with survivors.Do not over identify with survivors. 52

53 Ways to Manage Your Stress Talk out your stress- process your thoughts and reactions with someone else (coworker, therapist, clergy, friend, family, supervisor).Talk out your stress- process your thoughts and reactions with someone else (coworker, therapist, clergy, friend, family, supervisor). Learn about Compassion Fatigue.Learn about Compassion Fatigue. Build a positive support system that supports you, not fuels your stressBuild a positive support system that supports you, not fuels your stress Participate in memorials, rituals, and use of symbols as a way to express feelings.Participate in memorials, rituals, and use of symbols as a way to express feelings. 53

54 Ways to Manage Your Stress Take care of yourself: Exercise, Meditate, Get enough sleep, nutrition.Take care of yourself: Exercise, Meditate, Get enough sleep, nutrition. Do things outside of work that bring you joy and fuel your passion(s).Do things outside of work that bring you joy and fuel your passion(s). Find some alone time for yourself, nurture your spirit.Find some alone time for yourself, nurture your spirit. Humor…it can help to keep problems in perspective.Humor…it can help to keep problems in perspective. Use time off to decompress and recharge your batteries (music, exercise, read, relaxing meal, movie)Use time off to decompress and recharge your batteries (music, exercise, read, relaxing meal, movie) 54

55 Top 10… Things To Do In Coping with Stress 55

56 #10 Exercise 56

57 #9 Spend Time With Others 57

58 #8 Reach Out To Others 58

59 #7 Stay Calm 59

60 #6 Eat a Healthy Diet 60

61 #5 Do Things That Make You Feel Good 61

62 #4 Use the Power of Prayer 62

63 #3 Get Plenty of Rest 63

64 #2 Remember, You’re Not Crazy! 64

65 #1 Talk To Friends 65

66 Resources National Child Traumatic Stress Network (free PFA course)National Child Traumatic Stress Network (free PFA course) –http://learn.nctsn.org/ FEMA (free ICS courses)FEMA (free ICS courses) –http://training.fema.gov/is/nims.asp SAMHSASAMHSA –http://www.samhsa.gov/dtac/ International Critical Incident Stress FoundationInternational Critical Incident Stress Foundation –http://www.icisf.org/ 66

67 Resources DSHS acronym listDSHS acronym list –http://online.dshs.state.tx.us/library/acronym.htm TDEM websiteTDEM website –http://www.txdps.state.tx.us/dem/index.htm FEMA acronym listFEMA acronym list –http://www.fema.gov/plan/prepare/faat.shtm Centers for Disease ControlCenters for Disease Control –http://www.bt.cdc.gov/mentalhealth/ 67

68 Contact Information Disaster Behavioral Health Services 909 West 45 th Street Austin, TX (512)


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