Presentation on theme: "The Basic Skills of Disaster Behavioral Health"— Presentation transcript:
1The 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
2Identify 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.
3Course 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 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.
4Introductions Note to Facilitator: Intros 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?
5Role 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.Facilitator Notes: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 referral
6Role 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.
7Key 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.
8Stress 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 disastersTime Check: You should be at approximately 11am
9S T R E S SStress is the body's physical and mental reactions to events and circumstances that frighten, excite, confuse, endanger, or irritate
10A NORMAL REACTION in NORMAL PEOPLE to an ABNORMAL EVENT. StressA NORMAL REACTION in NORMAL PEOPLE to an ABNORMAL EVENT.
11Signs of Stress Reaction Concentration problemsAnxietyIdentification with victimsFlashbacksDifficulty sleepingChanges in eating habitsChanges in working habits
12Stress 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 SeyleSay: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)
13Stress 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 minutesReview 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?* Indicates a flag for professional referral
14Factors 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
15Maslow’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
16Phases of Recovery in a Disaster Situation ImpactHeroicHoneymoonInventoryDisillusionmentReconstructionFacilitator Note: 3 minutesDiscuss 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 placeInitial shock of the eventReactions include confusion, disbelief, and worryHigh activity concentrated on rescue efforts and evacuationCommunity cohesion as people come together to donate goods and servicesTemporary suspension of community tensions (e.g., between differentracial/ethnic groups)Anxiety intensified if family members are separatedHigh level of optimism as the community works togetherQuality of interaction between relief workers and survivors crucial toperceptions of the total relief effort as well as beliefs about recoverySurvivors recognize the limits of reliefSurvivors begin thinking about their futuresSurvivors realize the reality of their lossesHigh stress played out through personally destructive acts, family tension, andcommunity divisionPotential for hostility between neighbors and among communitiesReceiving assistance from relief agencies can be complicated and frustratingSurvivors feel powerless and angryOngoingAdapting to lifestyle and environmental changesStructural rebuilding
17AssignmentThink 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 breakTime Check: About 12 noon
18Activity 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.Add directions here:
19Basics 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.
20Psychological 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.
21Summary of Basic Principles of Psychological First Aid: Protect + Direct + ConnectContact and engagementSafety and comfortStabilizationFacilitator Note: 10 minutes for the next two slidesReview 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 chart
22Activity 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 discussionScenario 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)
23Protect + Direct + Connect Summary of Basic Principles of Psychological First Aid:Protect + Direct + ConnectInformation gathering: current need and concernsPractical assistance.
24Protect + Direct + Connect Summary of Basic Principles of Psychological First Aid:Protect + Direct + ConnectConnection with Social SupportsInformation on CopingLinkage with Collaborative Services
25Do’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 slidesReview bullets, give examples when ableAsk:What items do you see here that we discussed earlier today?Safety and security needs….up the chart
26Don’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?
27Crisis 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 interventionUse 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 their immediate situationsReestablish rational problem-solving abilitiesAn 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 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 situation
28Crisis • 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.
29Goals 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
30Steps 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 minutesTalk through the process of a crisis interventionGive examples
31Discuss chart of movement from victim to survivor to thriver
32Basic Skills of Crisis Intervention Active listeningReflectingNormalizingPrioritizingAssessmentStress managementHolding the bucketNote to Facilitator: 10 minutesReview slide using the text below as a guide as needed; demonstrating with examples when ableNote to participants this information is in their Helping to Heal Field GuideTips 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.
33Holding 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’
34Crisis Intervention Strategy I The LUV Triangle: Reach Out With LUV Note to Facilitator:Time Check: Should be no later than 1:40 hereCheck for understanding; ask if there are questions about anything that has been covered so far.You may need to take a break here
35Using 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
36LUV 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
37LUV 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
38Understanding 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 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
39LUV 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!
40Activity 3 - Part 1Divide into same pair grouping from introduction activityHave 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 reviewReview directions with group verbally – you will need to read them and repeat the directionsShow next slide to review the activity
41Activity 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
42Activity 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 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
43Activity 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
44Crisis Intervention Strategy II Finding the Survivor: Resiliency Facilitator Note:Ask for any comments/questions from what was just coveredTime check: Should be about 2:50 hereIntroduce the next section on finding the survivor and promoting resiliency
45Ask “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?
46Crisis 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:This is a review slide of the steps of crisis intervention review with participants
47Activity 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….
48Indicators 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 assessment
49Exercise - 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
50Are 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
51Special 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 topic
52Self Care As a Responder Use 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 handCan accept that as a job well doneThe 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 counseling
53Putting 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?
54ConclusionFinal QuestionsPlease complete class evaluationsThank You for Coming!