The Basic Skills of Disaster Behavioral Health

TADBHAC Joint Partnership With VDH/DMHMRSAS

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Housekeeping

Lunch plans Restrooms, exits Cell phones on vibrate, please exit the room to take calls Monitor your own stress level Materials You will have plenty of opportunities to be involved in the

learning process with activities and practice exercises. Schedule for the day

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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

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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

Introductions

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Role of Behavioral Health in a DisasterHow 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

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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

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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

Stress and Disasters

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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

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NORMAL REACTIONS to an ABNORMAL EVENT.

Stress

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Signs of Stress Reaction

Concentration problems Anxiety Identification with victims Flashbacks Difficulty sleeping Changes in eating habits Changes in working habits

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Stress

Good Stress/Bad Stress

Fight/Flight/Freeze/Faint Reaction

The next slide will be a test of your observational skills in identifying the subtle cues of stress. Look closely….

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Stress Reactions to a DisasterEmotional 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 ConfusionDistortion *Decreased self-esteem Decreased self-efficacySelf-blameIntrusive thoughts and memories Worry

Physical Effects Interpersonal Effects

Fatigue Insomnia Sleep disturbance Hyperarousal Somatic complaints Impaired immune responseHeadachesGastrointestinal problemsDecreased appetiteStartle response

AlienationSocial withdrawalIncreased conflict within relationships Vocational impairment School impairmentDesire for retaliation *Scapegoating

* Indicates a flag for professional referral

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Factors Influencing The Emotional Impact Of A Disaster

Disaster individual/community workerCharacteristics characteristics characteristics________________________________________________________________ With warning v. Individual expectations/Without warning characteristics experience

Time of day and social support diversityDuration systems

Geographic diversity/ physical/emotionalLocation demographics health

Scope of impact disaster history personal issues

Natural v. Previous trauma media coverageMan-made

Post-disaster communications impact of disaster on themEnvironment

Centralized v. Decentralized

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Maslow’s Hierarchy of Needs

Physiological Needs

Personal Safety

Social Affiliation

Self Esteem

Self Actualization

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Phases of Recovery in a Disaster Situation

Impact

Heroic

Honeymoon

Inventory

Disillusionment

Reconstruction

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Assignment

Think about advice or support you received during the disaster you described in the introduction. What was helpful?

What would have helped?

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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.

Basics of Psychological First Aid

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Psychological First Aid

Protect

Direct

Connect

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Contact and engagement

Safety and comfort

Stabilization

Summary of Basic Principles of Psychological First Aid:

Protect + Direct + Connect

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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

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Protect + Direct + Connect

Information gathering: current need and concerns

Practical assistance

Summary of Basic Principles of Psychological First Aid:

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Protect + Direct + Connect

Connection with Social Supports

Information on Coping

Linkage with Collaborative Services

Summary of Basic Principles of Psychological First Aid:

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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.

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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.

Crisis Intervention

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Crisis

• Distinct From Trauma & Disorder• Turning Point• Momentous Decision• Danger and Opportunity

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Goals of Crisis Intervention

Enhance Opportunities

Stabilize

Reduce Dangers

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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

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Basic Skills of Crisis Intervention

Active listening Reflecting Normalizing Prioritizing Assessment Stress management Holding the bucket

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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?)

Crisis Intervention Strategy IThe LUV Triangle: Reach Out With LUV

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Listen

Understand

Validate

The LUV Triangle

Using the LUV Triangle

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• Face and give the person your undivided attention.

• Lean toward the person and make eye contact.

Listen

Understand

Validate

The LUV Triangle

LUV Triangle: Listen

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LUV Triangle: Understand

• Repeat or paraphrase what the person is saying.

• Check your understanding.

Listen

Understand

Validate

The LUV Triangle

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Understanding and RespondingEmpathetic Response leads So you feel . . . I hear you saying . . . I sense that you are feeling . . . You appear . . . It seems to you . . . You place a high value on . . .

Helpful Response Leads So. . I am listening Tell me more about that… Sounds like talking about that is hard for you…. Sometimes talking about it helps…. Sounds like you are angry about that ……

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LUV Triangle: Validate

• Offer minimal encouragers, such as the “lassie twist.”

• Show your faith in the person by not giving glib advice.

Listen

Understand

Validate

The LUV Triangle

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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.

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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?

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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?

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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?

Crisis Intervention Strategy IIFinding the Survivor: Resiliency

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Ask “getting through” questions "How did you get yourself to do that?" "What did you draw from inside yourself

to make it through that experience?"

Ask “making meaning” questions “As you begin to make more sense of

this, what information have you learned so far?”

“What advice would you give somebody who was going through what you faced?”

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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

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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

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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)

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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?

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Special Considerations

Elderly Persons with mental illness Children Physically Challenged WorkforceCultural and ethnic differences

Are You Ready?Personal Preparedness As a Responder

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Self Care As a Responder

Be Prepared! Have an emergency kit

Use the buddy system

Take breaks; Rotate shifts

Monitor your own stress level

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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?

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Conclusion

Final Questions

Please complete class evaluations

Thank You for Coming!