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The Basic Skills of Disaster Behavioral Health TADBHAC Joint Partnership With VDH/DMHMRSAS.

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Presentation on theme: "The Basic Skills of Disaster Behavioral Health TADBHAC Joint Partnership With VDH/DMHMRSAS."— Presentation transcript:

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2 The Basic Skills of Disaster Behavioral Health TADBHAC Joint Partnership With VDH/DMHMRSAS

3 2 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

4 3 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

5 4 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

6 Introductions

7 6 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

8 7 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

9 8 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

10 Stress and Disasters

11 10 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

12 11 NORMAL REACTIONS to an ABNORMAL EVENT. Stress

13 12 Signs of Stress Reaction Concentration problems Anxiety Identification with victims Flashbacks Difficulty sleeping Changes in eating habits Changes in working habits

14 13 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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18 17 Stress Reactions to a Disaster Emotional EffectsCognitive 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 EffectsInterpersonal 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 * Indicates a flag for professional referral

19 18 Factors Influencing The Emotional Impact Of A Disaster Disaster individual/community worker Characteristicscharacteristicscharacteristics ________________________________________________________________ With warning v.Individual expectations/ Without warningcharacteristics experience Time of day and social supportdiversity Durationsystems Geographicdiversity/physical/emotional Locationdemographicshealth Scope of impactdisaster historypersonal issues Natural v.Previous traumamedia coverage Man-made Post-disastercommunications impact of disaster on them Environment Centralized v. Decentralized

20 19 Maslows Hierarchy of Needs Physiological Needs Personal Safety Social Affiliation Self Esteem Self Actualization

21 20 Phases of Recovery in a Disaster Situation Impact Heroic Honeymoon Inventory Disillusionment Reconstruction

22 21 Assignment Think about advice or support you received during the disaster you described in the introduction. What was helpful? What would have helped?

23 22 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.

24 Basics of Psychological First Aid

25 24 Psychological First Aid Protect Direct Connect

26 25 Contact and engagement Safety and comfort Stabilization Summary of Basic Principles of Psychological First Aid: Protect + Direct + Connect

27 26 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

28 27 Protect + Direct + Connect Information gathering: current need and concerns Practical assistance Summary of Basic Principles of Psychological First Aid:

29 28 Protect + Direct + Connect Connection with Social Supports Information on Coping Linkage with Collaborative Services Summary of Basic Principles of Psychological First Aid:

30 29 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.

31 30 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.

32 Crisis Intervention

33 32 Crisis Distinct From Trauma & Disorder Turning Point Momentous Decision Danger and Opportunity

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37 36 Goals of Crisis Intervention Enhance Opportunities Stabilize Reduce Dangers

38 37 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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40 39 Basic Skills of Crisis Intervention Active listening Reflecting Normalizing Prioritizing Assessment Stress management Holding the bucket

41 40 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?)

42 Crisis Intervention Strategy I The LUV Triangle: Reach Out With LUV

43 42 Using the LUV Triangle

44 43 Face and give the person your undivided attention. Lean toward the person and make eye contact. LUV Triangle: Listen

45 44 LUV Triangle: Understand Repeat or paraphrase what the person is saying. Check your understanding.

46 45 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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48 47 LUV Triangle: Validate Offer minimal encouragers, such as the lassie twist. Show your faith in the person by not giving glib advice.

49 48 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 11 th, 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.

50 49 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?

51 50 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?

52 51 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?

53 Crisis Intervention Strategy II Finding the Survivor: Resiliency

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56 55 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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59 58 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

60 59 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

61 60 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)

62 61 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?

63 62 Special Considerations Elderly Persons with mental illness Children Physically Challenged Workforce Cultural and ethnic differences

64 Are You Ready? Personal Preparedness As a Responder

65 64 Self Care As a Responder Be Prepared! Have an emergency kit Use the buddy system Take breaks; Rotate shifts Monitor your own stress level

66 65 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?

67 66 Conclusion Final Questions Please complete class evaluations Thank You for Coming!


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