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The Basic Skills of Disaster Behavioral Health

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1 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

2 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.

3 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 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.

4 Introductions Note to Facilitator: Intros
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?

5 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. Facilitator Notes: 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

6 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.

7 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.

8 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 Time Check: You should be at approximately 11am

9 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

10 A NORMAL REACTION in NORMAL PEOPLE to an ABNORMAL EVENT.
Stress A NORMAL REACTION in NORMAL PEOPLE to an ABNORMAL EVENT.

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

12 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 Seyle 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)

13 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? * Indicates a flag for professional referral

14 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

15 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

16 Phases of Recovery in a Disaster Situation
Impact Heroic Honeymoon Inventory Disillusionment Reconstruction Facilitator Note: 3 minutes 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 Initial shock of the event Reactions include confusion, disbelief, and worry High activity concentrated on rescue efforts and evacuation Community cohesion as people come together to donate goods and services Temporary suspension of community tensions (e.g., between different racial/ethnic groups) Anxiety intensified if family members are separated High level of optimism as the community works together Quality of interaction between relief workers and survivors crucial to perceptions of the total relief effort as well as beliefs about recovery Survivors recognize the limits of relief Survivors begin thinking about their futures Survivors realize the reality of their losses High stress played out through personally destructive acts, family tension, and community division Potential for hostility between neighbors and among communities Receiving assistance from relief agencies can be complicated and frustrating Survivors feel powerless and angry Ongoing Adapting to lifestyle and environmental changes Structural rebuilding

17 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 lunch at this point; either break for lunch or give 10 minute bio break Time Check: About 12 noon

18 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. Add directions here:

19 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.

20 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.

21 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

22 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 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)

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

24 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

25 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

26 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?

27 Crisis Intervention Facilitator Notes: 5 minutes
Discuss how crisis intervention is different from psychological first aid. Discuss psychological first aid as a broader intervention; in providing this service you may find some people need more service; such as crisis intervention 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 their immediate situations Reestablish rational problem-solving abilities An underlying assumption is that the survivor’s distress and coping difficulties are due to the suddenness, horror, and catastrophic 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

28 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.

29 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

30 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

31 Discuss chart of movement from victim to survivor to thriver

32 Basic Skills of Crisis Intervention
Active listening Reflecting Normalizing Prioritizing Assessment Stress management Holding the bucket Note to Facilitator: 10 minutes Review slide using the text below as a guide as needed; demonstrating with examples when able Note to participants this information is in their Helping to Heal Field Guide 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 and hears what they are saying. 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.

33 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’

34 Crisis Intervention Strategy I The LUV Triangle: Reach Out With LUV
Note to Facilitator: Time Check: Should be no later than 1:40 here Check for understanding; ask if there are questions about anything that has been covered so far. You may need to take a break here

35 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

36 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

37 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

38 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 and hears what they are saying. 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

39 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!

40 Activity 3 - Part 1 Divide into same pair grouping from introduction activity 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 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

41 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

42 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 Dorinda: 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

43 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

44 Crisis Intervention Strategy II Finding the Survivor: Resiliency
Facilitator Note: Ask for any comments/questions from what was just covered Time check: Should be about 2:50 here Introduce the next section on finding the survivor and promoting resiliency

45 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?

46 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: This is a review slide of the steps of crisis intervention review with participants

47 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….

48 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

49 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

50 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

51 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

52 Self Care As a Responder
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 Can accept that as a job well done 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

53 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 know when to go? How do I know what to do when I get there? Should I self-deploy?

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


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