Presentation on theme: "The Basic Skills of Disaster Behavioral Health"— Presentation transcript:
1 The Basic Skills of Disaster Behavioral Health Note to Faciilitator:Show Title SlideMake introductions individually if you can as learners enter the roomTADBHAC Joint Partnership With VDH/DMHMRSAS
2 Housekeeping Lunch plans Restrooms, exits Cell phones on vibrate, please exit the room to take callsMonitor your own stress levelMaterialsYou will have plenty of opportunities to be involved in the learning process with activities and practice exercises.Schedule for the dayNote to Facilitator: - 2 minutesReview slideMake any additional housekeeping announcements needed, regional trainer at your site will have logistics announcements about lunchReview what materials they should have; a folder withHand out of presentationField guide for Helping to HealPsychological First Aid manualPersonal preparedness brochureClass evaluationThey will receive certificate of completion at end of the dayEmphasize 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..)
3 Identify range of responses to disasters Course ObjectivesIdentify range of responses to disastersExplain survivor hierarchy of needs during a disasterIdentify methods for self care during disasters; Self-preparedness; Utilizing buddy systemDemonstrate the basic skills and techniques of psychological first aidNote to Facilitator: - 3 minutesReview objectives slide with the classSay: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.
4 Course Objectives (Continued) Explain concepts of crisis intervention, resilience, and using a strengths based model in resolving crisisDemonstrate basic skills of crisis interventionIdentify the boundaries of your roleIdentify indicators for referral and abuse reportingRecognize special population considerationsNote to Facilitator: - 3 minutesReview objectives slide with the class - continued
5 Introductions Note to Facilitator: Intros Ask general audience questions about experience in disastersWho has been in a disaster?How will that help you today?How did you get through a disaster?
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 beRange of interventions; Immediate crisis intervention, psychological first aid, referral to servicesCSB’s have an all hazards behavioral health response planEveryone is a resourceFacilitator Notes: 3 minutesSay: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 bulletsDiscuss range of disaster mental health interventions and give an example if possibleRapid assessment and triageCrisis interventionSupportive listeningProblem-solving immediate issuesEducation about disaster stressDebriefing and community meetingsInformation and referralReferences: H2-MODULES 3 AND 4 DESCRIBE CSB ROLES, PLANNING AND CRISIS COUNSELING PROGRAMS PAGES 40-79
7 Role of Behavioral Health in a Disaster What is paraprofessional role in a disaster?Liaison, greeter, disaster support workerServe as supportive, empathetic listenerProvide education and outreachRefer individuals as neededWhere might it occur?Everywhere!Point of dispensing sites, shelters, health care sites, hospitals emergency operations centers, feeding sites, first responder respite sites2-3 minutesNote 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
8 Key Concepts of Disaster Behavioral Health Normal reactions to abnormal situationsAvoid ”mental health” terms and labelsPractical assistance has a powerful psychological impactAssume competence and resilienceFocus on strengths resources and potentialEncourage use of support networkActive, community fitInnovative helpingFacilitator Notes: - 20 minutesReview these concepts;provide examples when ableCheck 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 PGSPFA: PG 4
9 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
10 S T R E S SStress is the body's physical and mental reactions to events and circumstances that frighten, excite, confuse, endanger, or irritateRead definition to participantsAsk class: What is your reaction to that? Seem accurate? Any questions or comments it brings up for you?
11 NORMAL REACTIONS to an ABNORMAL EVENT. StressNORMAL REACTIONS to an ABNORMAL EVENT.Read slideAsk for examples of this statement
12 Signs of Stress Reaction Concentration problemsAnxietyIdentification with victimsFlashbacksDifficulty sleepingChanges in eating habitsChanges in working habitsReview slide with participantsReference Point: H2: pg 86
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….Note to Facilitator: 5 minutesDiscuss each of these bulleted conceptsGood Stress/Bad StressGood Stress – any stress event that increases performance and the ability to respondBad Stress- Any stress event that overwhelms and decreases your ability to respond, leads to emotional upset or physical illnessInternal/External stressNormal response to abnormal event – it is the event that is abnormal; not the response to the eventFlight/Fight/Freeze Reaction – briefly discuss this conceptSay: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)
14 Note to Facilitator:Note: minutes for next 3 slidesAsk:What signs of stress do you notice in this picture?Say:Now, the next picture will be of a real human being under stress.
15 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.
16 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?
17 Stress Reactions to a Disaster Emotional EffectsCognitive EffectsShockAngerDespairEmotional numbingTerrorGuiltGrief or sadnessIrritabilityHelplessnessLoss of derived pleasure from regular activitiesDissociation (e.g., perceptual experience seems “dreamlike,” “tunnel vision,” “spacey,” or on “automatic pilot”) *Impaired concentrationImpaired decision-making abilityMemory impairmentDisbeliefConfusionDistortion *Decreased self-esteemDecreased self-efficacySelf-blameIntrusive thoughts and memoriesWorryPhysical EffectsInterpersonal EffectsFatigueInsomniaSleep disturbanceHyperarousalSomatic complaintsImpaired immune responseHeadachesGastrointestinal problemsDecreased appetiteStartle responseAlienationSocial withdrawalIncreased conflict within relationshipsVocational impairmentSchool impairmentDesire for retaliation *ScapegoatingNote to Facilitator: 2-3 minutes Review some highlights of this chart; give examplesSay: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
18 Factors Influencing The Emotional Impact Of A Disaster Disaster individual/community workerCharacteristics characteristics characteristics________________________________________________________________With warning v. Individual expectations/Without warning characteristics experienceTime of day and social support diversityDuration systemsGeographic diversity/ physical/emotionalLocation demographics healthScope of impact disaster history personal issuesNatural v. Previous trauma media coverageMan-madePost-disaster communications impact of disaster on themEnvironmentCentralized v.DecentralizedNote to facilitator: 2-3 minutesDiscuss slideRefer back to the original stories during introduction activityRefer to reference page giving definitions at the back of the ppt presentation
19 Maslow’s Hierarchy of Needs Self ActualizationSelf EsteemSocial AffiliationFacilitator Note: minutesDiscuss SlideMake 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 metAsk: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 supportPersonal SafetyPhysiological Needs
20 Phases of Recovery in a Disaster Situation ImpactHeroicHoneymoonInventoryDisillusionmentReconstructionFacilitator Note: 3 minutes H2 PGSDiscuss slidePersonal and community level of recovery facilitate this discussionCaution 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
21 AssignmentThink 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
22 Activity 1: Disaster Charades Break up into 6 equal groupsUsing 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
23 Basics of Psychological First Aid Facilitator Note:When returning from break; take responses from the group about the question asked prior to the breakMake 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.
24 Psychological First Aid ProtectDirectConnectFacilitator Notes: 2 minutesReview the 3 concepts of psychological first aid; the text below is a guideSurvivors 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
25 Summary of Basic Principles of Psychological First Aid: Protect + Direct + ConnectContact and engagementSafety and comfortStabilizationFacilitator Note: 10 minutes for the next two slides Review slideMake some comparisons – where does this apply in the Maslow chart and the immediate phase of dealing with a disasterAsk:What items do you see here that we discussed earlier today?Safety and security needs….up the chartReference Point: PFA PGS 11-19
26 Activity 2: Psychological First Aid Break up into 4 groupsUsing page 10 in the manual using concepts 1 and 2 only discuss the disaster scenario given to you by your facilitatorAnswer 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 discussionActivity 2: 15 minutesScenario examplesHospital parking lotRecovery scene of a tornado; parking lot in school filled with parents; provide psychological first aidWhat would you find yourself doing? (provide safety and comfort)
27 Protect + Direct + Connect Summary of Basic Principles of Psychological First Aid:Protect + Direct + ConnectInformation gathering: current need and concernsPractical assistanceReview SlideReference Point: PFA : PGS 20-25
28 Protect + Direct + Connect Summary of Basic Principles of Psychological First Aid:Protect + Direct + ConnectConnection with Social SupportsInformation on CopingLinkage with Collaborative ServicesReview SlideReference Point: PFA: PGS 26-39
29 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 ableAsk:What items do you see here that we discussed earlier today?Safety and security needs….up the chartReference Point: H2: PGS PFA: PG 6
30 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 sayingAsk:Any “don’ts” surprise anyone?Reference Points: PFA: PG 7; PG 54 DEATH;H2: CULTURAL COMPETENCE
31 Crisis Intervention Facilitator Notes: 5 minutes Discuss how crisis intervention is different from psychological first aid.Use the points below as a guide if neededWhile 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 lifeReestablish rational problem-solving abilitiesAn 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 solutionsAssessing 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 situationReference Point: H2: PG
32 Crisis • Distinct From Trauma & Disorder • Turning Point • Momentous Decision• Danger and OpportunityFacilitator Note: 5 minutesReview the slide making the following points:It can occur in response to trauma and disorder;Is usually a pivotal point for a personCan be a joyful or traumatic experienceTrauma 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.
33 Facilitator Note: 1 minute Should see picture of Chinese symbol of crisisDanger and opportunity
34 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.
35 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.
36 Goals of Crisis Intervention Enhance OpportunitiesStabilizeReduce DangersFacilitator Note: 2 minutesRelate this back to the protect, direct, connect and the slide for Chinese symbol of crisisThese are the same goals as psychological first aidExample: 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
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 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 solutionsAssessing functioning and coping skills (e.g., asking how he or she is doing, making referrals if needed)Providing reassurance, normalization, psycho education, and practical assistanceNote to Facilitator: 5 minutes Talk through the process of a crisis interventionGive examplesReference Point: H2 PG THIS IS THE REVISED EDITION!
38 Discuss chart of movement from victim to survivor to thriver
39 Basic Skills of Crisis Intervention Active listeningReflectingNormalizingPrioritizingAssessmentStress managementHolding the bucketNote to Facilitator: 10 minutesReference Point: PFA: ASSESSMENT 20-24Review slide using the text below as a guide as needed; demonstrating with examples when ableTips 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 listeningAllow for silence, if appropriate—Silence gives the survivor time to reflect and become aware of feelings and can prompt the survivor to elaborate.
40 Holding the BucketPeople need to tell their story and they need you to listen while they doPace your breathing with speaker and then begin to slow them downBody language and eye contact are a must for interactionDo not interrupt/intrude on another counselorAllow one to vent with out trying to defend or bashResistant to self-disclosure… ask about spouse, children (coping with?)Facilitator Note: 5 minutesReview bullet pointsDiscuss what we mean by “holding the bucket’
41 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
42 Using the LUV Triangle Note to Facilitator: This section introducing the LUV triangle should take about 20 minutes for next 6 slidesIntroduce this LUV model as any easy way to remember how to respondComment on this as the empathic connection
43 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 pointThe art of listening has three parts:Listening to and understanding nonverbal behaviorListening to and understanding verbal messagesListening to and understanding the person
44 LUV Triangle: Understand • Repeat or paraphrase what the person is saying.• Check your understanding.Facilitator Note:Discuss examples of paraphrasing and checking your understandingAsk the participants to give examples from their own work and personal lives
45 Understanding and Responding Empathetic Response leadsSo 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 LeadsSo. . I am listeningTell 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 neededParaphrase—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 listeningAllow 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
46 Facilitator Note:Comment on physical communication of connectionSay: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.
47 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 resilienceGive examples of responses; ask participants for examplesSay: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!
48 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 reviewReview directions with group verbally – you will need to read them and repeat the directionsShow next slide to review the activity
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?Facilitator Note:Debrief activityWhen participants are providing feedback on experiences; Add in nuance of identifying strengths and finding the survivor
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?Facilitator Note: 20 minutes timeframe for Part 2 activity; including reviewReview directions with group verbally – you will need to read them and repeat the directionsPrepare 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
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?Facilitator Note:When participants are providing feedback on experiences; again, add in nuance of identifying strengths and finding the survivorAsk audience why this exercise is important;Be sure to give enough time to debrief this activityTake another break here; 5 minutes
52 Crisis Intervention Strategy II Finding the Survivor: Resiliency Facilitator Note:Ask for any comments/questions from what was just coveredIntroduce the next section on finding the survivor and promoting resiliency
53 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 victimEmbedded 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;
54 Facilitator Note:This should be picture of house devastated by KatrinaComment 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?
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?”Facilitator Note:Discuss questions that help presume competence and resilience; broaden victim story to one of survival; the text below is a guideOne 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 flipchartBelow 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
56 Facilitator Note;This picture is Portraying their survival and getting back together with friendsThis is after Katrina in Mississippi
57 Facilitator Note:Pascagoola Mississippi; a survivors journal of how she and her family were surviving after Hurricane KatrinaAll are pictures emphasizing resilience and survival
58 Crisis InterventionCrisis 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 solutionsAssessing functioning and coping skills (e.G., Asking how he or she is doing, making referrals if needed)Providing reassurance, normalization, psycho education, and practical assistanceFacilitator Note: REPEAT OF SLIDE 33This is a review slide of the steps of crisis intervention review with participantsReference Point: H2: PG
59 Activity 4 – Crisis Intervention Break up into pairsUsing the scenarios from Activity 2 role play a crisis intervention scenario with your partner using the information on the previous slide as a guideTake turns with each of you being the victim and the helperFacilitator Notes: 15 minutesAt least one of the pair practice providing crisis interventionDisaster 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 referralWhat are you doing different in crisis intervention; go through the steps finding strengths, etc….
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 recoveryThe person or family member reports uncontrollable crying, muteness, feelings of unreality, is hearing voices or seeing things or experiencing ongoing paranoiaThe 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: minutesReview slide bulletsBe 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 assessmentReference Point: H2 PG 97
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.QuestionsWhat information is important to gather here?What resources would you mobilize?Facilitator Note: 10 minutesComplete this activity as a large groupReview the scenario and discuss questions as a groupBe sure discussion includes:Critical components in the scenarioHow to and who is the MH professional in the area to be contactedRole of the paraprofessional to be an expansion of the eyes and ears of MH
62 Special Considerations Elderly Persons with mental illness Children Physically Challenged Workforce Cultural and ethnic differencesFacilitator Notes: 3 minutesAsk: 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 madeDiscuss with Class:Example – member of mental retardation community; relive disaster by watching TVDelayed reactionsExample – do you have to be present to be affected by disaster?Ask for final questions on this topicReference Points: H2: ; ; ; ; KIDS ELDERS ; DEATHPFA: DEATH; KIDS
63 Are You Ready? Personal Preparedness As a Responder Facilitator Note:Introduce that in order to be an effective responder you have to be preparedPoint out personal preparedness materials in their packets
64 Self Care As a Responder Be Prepared! Have an emergency kitUse the buddy systemTake breaks; Rotate shiftsMonitor your own stress levelFacilitator Note: 5 minutesDiscuss bullet points on slide using text below as a guideSelf-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 solveCan still strive to provide the best possible services within the limitations of the situation at handThe following are ways to maintain emotional and physical health:Limiting the amount of time spent watching television coverage of the terrorist eventStaying physically healthy—exercising, eating right, and getting restSticking to routines as much as possibleStress at the event site can be relieved by:Taking breaks or going for walksRotating shifts with coworkersTalking with a supervisor or other team members about the challenges of disaster counselingReference Points: H2:
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?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?
66 ConclusionFinal QuestionsPlease complete class evaluationsThank You for Coming!