Keeping the Keeping the Faith: Faith:

Disaster CareDisaster CareSheldon RosenzweigSheldon Rosenzweig

Compassion Coalition of Tuscaloosa Compassion Coalition of Tuscaloosa County, Inc.County, Inc.

Presented December 4, 2008Presented December 4, 2008

This presentation is adapted from FEMA CCP Training, This presentation is adapted from FEMA CCP Training, NIOSH, CDC, Washington State Department of Mental NIOSH, CDC, Washington State Department of Mental Health, Project Rebound (Alabama State Department of Health, Project Rebound (Alabama State Department of

Mental Health) and other sources.Mental Health) and other sources.

Overview Overview

Characteristics of Disasters and Reactions

Stress and Grief – Be Your Own Advocate

Coping and Recovery – Tests of Faith

Professional Care – Giving and Receiving

Every Disaster is Every Disaster is DifferentDifferent

Disasters cause disruption and changes that can include:• Loss of life and/or property;• Injury and/or illness;• Disruption of community support systems and/or infrastructure;

• Disruption to family and/or relocation;• Unemployment;• Changes in school configurations;• Interaction with large bureaucracies; • Influx of outsiders into the community; and

• Increase in substance use or abuse.

Community Reactions:Community Reactions:Phases of DisasterPhases of Disaster

Adapted from CMHS, 2000.

Disaster ReactionsDisaster Reactions People pull together during

and after a disaster; Stress and grief are common

reactions to an uncommon situation;

Most people’s natural resilience and support systems will support their recovery;

Some may question faith.

Key Concepts of Key Concepts of Disaster ReactionsDisaster Reactions

Small percentage will have severe Small percentage will have severe adverse emotional, psychological, or adverse emotional, psychological, or substance use/abuse reactions; substance use/abuse reactions;

Very few progress into diagnosable Very few progress into diagnosable mental health or substance abuse mental health or substance abuse conditions;conditions;

People typically do not seek mental People typically do not seek mental health or substance abuse treatment health or substance abuse treatment services (self-reliance at all costs, services (self-reliance at all costs, stigma issues, reliance on faith alone); stigma issues, reliance on faith alone); andand

Survivors often reject help (“others Survivors often reject help (“others need it more than I do”).need it more than I do”).

At-Risk Populations At-Risk Populations (Potential Risk (Potential Risk

Groups)Groups) Children, Youth, and Adults with Children, Youth, and Adults with

Children;Children; Older Adults;Older Adults; People with Serious Mental Illnesses;People with Serious Mental Illnesses; People with Disabilities;People with Disabilities; Special Socioeconomic Groups; Special Socioeconomic Groups; First Responders/Public Safety First Responders/Public Safety

Workers; Workers; andand People with a History of Substance People with a History of Substance

Abuse.Abuse.

Being Your Own Best Being Your Own Best Advocate:Advocate:

It’s Okay to Take Care of It’s Okay to Take Care of YourselfYourself Dealing with persons and clients in a

crisis is very stressful; Dealing with bureaucracies and

other aid groups in a crisis can also be stressful;

Prioritize recovery tasks to reduce stress;

Maintain good lines of communication with other groups and agencies;

Assist co-workers and staff in using skills such as communication techniques, problem solving, conflict resolution, and stress management.

Dealing with the Weight of Dealing with the Weight of DisastersDisasters

For some crisis volunteers and workers, disasters -

May trigger memories of previous disasters or other trauma;

May cause spiritual exhaustion; Old negative behaviors may

reappear.

Disaster Recovery Disaster Recovery Combats Negative Combats Negative

ReactionsReactions

PTSD; Flashbacks and Reliving; Unhealed Grief; Inappropriate Spirituality;Cumulative Effect of Crisis Work.

Importance of Importance of Co-Worker/Peer SupportCo-Worker/Peer Support

Exchanging information on life Exchanging information on life situations helps develop new ways situations helps develop new ways of adapting (of adapting (turn to your right, give turn to your right, give that person your business cardthat person your business card););

Increasing social support network Increasing social support network helps develop better relationships;helps develop better relationships;

Sharing of similar stories helps to Sharing of similar stories helps to normalize each other’s experience.normalize each other’s experience.

Isolation does not work!Isolation does not work!

Ways to Encourage Ways to Encourage RecoveryRecovery

Reminder that faith is an avenue of recovery; Reminder that faith is an avenue of recovery; Foster support systems with friends and Foster support systems with friends and

family;family; Exercise, diet, and healthy sleeping patterns;Exercise, diet, and healthy sleeping patterns; Humor is good;Humor is good; Take a mental health day. Take a mental health day.

Community SupportCommunity Support• Community gatherings,

memorials, and rituals promote recovery;

• Sharing with others who have similar experiences lessens the burden;

• Participating in the natural community recovery process, sometimes by just being a “compassionate presence” aids healing;

• Acknowledging that there are many spiritual paths to recovery respects diversity.

Types of Disaster ReactionsTypes of Disaster Reactions

The following are some kinds of individual reactions that may be experienced by disaster survivors:

Physical; Emotional; Cognitive; and Behavioral.

Physical ReactionsPhysical Reactions Gastrointestinal problems; Headaches, other aches and pains; Weight loss or gain; Sweating or chills; Tremors or muscle twitching; Being easily startled; Chronic fatigue or sleep

disturbances; and Immune system disorders.

Positive Responses include alertness and activation.

Emotional ReactionsEmotional Reactions Feeling heroic, euphoric, or

invulnerable; Denial; Anxiety or fear; Depression; Guilt; Apathy; and Grief.

Positive Responses include feeling challenged, involved, and pressured to act.

Cognitive ReactionsCognitive Reactions Memory problems; Disorientation and confusion; Slow thought processes, lack of

concentration; Difficulty setting priorities or making

decisions; Loss of objectivity; Recurring dreams or nightmares or

flashbacks; Preoccupation with disaster; Avoidance; and Questioning spiritual beliefs.

Positive Responses include determination, sharper perception, and fearlessness.

Behavioral ReactionsBehavioral Reactions Increase or decrease in activity level; Substance use or abuse (alcohol and/or

drugs); Difficulty communicating or listening; Irritability, outbursts of anger, frequent

arguments; Inability to rest or relax; Decline in job performance, absenteeism; Frequent crying; Hyper-vigilance or excessive worry; and Avoidance of activities or places that trigger

memories.

Positive Responses include affiliation, helping response, and altruistic behavior.

When to Seek or When to Seek or Recommend Professional Recommend Professional

HelpHelpSome possible indicators for more professional help are:

Poor work or family relationship functioning;

Suicidal thoughts; Alcohol or drug use/abuse; Phobically avoiding important situations; Auditory, visual, tactile, or olfactory

hallucinations, paranoia, or delusions; Severe sleeping problems and/or panic

attacks; Doesn’t feel like eating or getting out most

days; Can’t stop thinking about the event; Can’t enjoy life at all; and Acting very differently from before the

trauma.

Person has suicide plan and/or means;

Person has homicidal ideation plan and intent/means to harm others;

Functioning is so poor that person’s (or dependent’s) safety and welfare is endangered;

Excessive substance use puts person or others at risk; and

Severe psychiatric symptoms (such as psychosis or major depression).

When Is Professional Care When Is Professional Care Urgent?Urgent?

When is Faith When is Faith Questioned ?Questioned ?

Disaster equals loss and upheaval. Survivors suffer loss of safety and security, loss of property, loss of community, loss of a job, loss of status, loss of health, home, pets, friends, or a loved one.

The recovery process through mourning and grief may involve questioning of faith. This is normal behavior.

Some Stages of GriefSome Stages of Grief

Denial – It can’t be true! Anger – Powerlessness. Depression - Loss, grief and

detachment. Acceptance – Looking toward the

future.

The normal process of mourning takes several months or even years.

Sudden DeathSudden Death No preparation, unfinished

business No goodbye Can overwhelm the survivors Sense of unreality Search for the reason Sense of helplessness Feelings of rejection &

abandonment

Informing a Person of Informing a Person of DeathDeath Only about 50% of the

persons who die each year do so in a hospital.

The rest leave survivors who are informed of the death by neighbors, friends, family, caregivers, police officers, clergy, etc.

All of us may have to do this task at some point, and not just during a disaster.

Protocol for Disaster Protocol for Disaster Personnel (Iowa State Personnel (Iowa State

Model)Model) Speak in a private area. Notify the parent, partner, or child in

person. Whenever possible, go with another

volunteer, policeman, clergy, family member, etc.

Deliver the news as soon as possible once identity has been positively established. Do not wait until morning.

Protocol, continuedProtocol, continued

Use plain, direct language. Say “dead, died, was killed”, not “passed away” or “fatally injured”.

Refer to the deceased by name, not “the body.” Show compassion. Expression of grief may take

many forms. Remain with the family for at least 30 minutes,

but not so long as to intrude on a very private time.

Answer questions if asked, but do not speculate. Speak in a clear and sympathetic way. Leave a written phone number for follow-up contact.

Disasters Do Not Disasters Do Not DiscriminateDiscriminate

Everyone is affected. It does not matter where you live.

It does not matter who your Higher Power is.

It does not matter what you do for a living.

Everybody suffers.

Men in DisastersMen in Disasters Immediately after a disaster, care often Immediately after a disaster, care often

focuses on women. Women are more focuses on women. Women are more verbal. verbal.

Men hurt, too. Men often try to work Men hurt, too. Men often try to work through pain alone, in a more private through pain alone, in a more private manner.manner.

Men may try to deny their feelings and Men may try to deny their feelings and appear strong for their families.  Pain appear strong for their families.  Pain denied sometimes translates to anger, denied sometimes translates to anger, negative behaviors and questioning of faith. negative behaviors and questioning of faith.

It is important for men survivors not to It is important for men survivors not to isolate themselves, especially from other isolate themselves, especially from other men.men.

Women in DisastersWomen in Disasters Surviving a natural disaster lowers the Surviving a natural disaster lowers the

life expectancy for women more than life expectancy for women more than men.men.

The stronger the disaster, The stronger the disaster, the greater the effect. the greater the effect.

It is important for women disaster It is important for women disaster survivors to take good care of survivors to take good care of themselves, find ways to reduce stress, themselves, find ways to reduce stress, make health and therapy appointments, make health and therapy appointments, and develop new social networks.and develop new social networks.

Recovery Phase: The Recovery Phase: The Good NewsGood News

You have been through a You have been through a life-changing event. Healing life-changing event. Healing takes time. Be patient with takes time. Be patient with yourself and others.yourself and others.

There is the potential for There is the potential for post-traumatic growth. post-traumatic growth. About 10% of disaster About 10% of disaster survivors will experience survivors will experience emotional and emotional and developmental growth developmental growth following a disaster. following a disaster.

Thank YouThank You

Funding for this program has been made available by the

American Red Cross Hurricane Recovery Program

and United Ways of Alabama

The American Red Cross is especially qualified to be a partner in recovery due to its extensive experience in responding to major national disasters. The Hurricane Recovery Program (HRP) is committed to helping survivors on the road to recovery while providing careful stewardship and accountability for the resources entrusted to it by the American public.

Sheldon L. Rosenzweig, MA, Sheldon L. Rosenzweig, MA, LPCLPC

P.O. Box 2312P.O. Box 2312

Tuscaloosa, AL Tuscaloosa, AL 3540335403

205-391-9520205-391-9520

slrosenz@aol.coslrosenz@aol.comm

Special Thanks to: Special Thanks to:

Compassion Coalition of Tuscaloosa County.Compassion Coalition of Tuscaloosa County.