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The Basic Skills of Disaster Behavioral Health. TADBHAC Joint Partnership With VDH/DMHMRSAS. Course Objectives. Identify range of responses to disasters Explain survivor hierarchy of needs during a disaster

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the basic skills of disaster behavioral health

The Basic Skills of Disaster Behavioral Health

TADBHAC Joint Partnership With VDH/DMHMRSAS

course objectives
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
course objectives continued
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
role of behavioral health in a disaster
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
role of behavioral health in a disaster1
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 respitesites
key concepts of disaster behavioral health
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
s t r e s s
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

signs of stress reaction
Signs of Stress Reaction
  • Concentration problems
  • Anxiety
  • Identification with victims
  • Flashbacks
  • Difficulty sleeping
  • Changes in eating habits
  • Changes in working habits
stress
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….

stress reactions to a disaster
Stress Reactions to a Disaster

* Indicates a flag for professional referral

factors influencing the emotional impact of a disaster
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

maslow s hierarchy of needs
Maslow’s Hierarchy of Needs

Self Actualization

Self Esteem

Social Affiliation

Personal Safety

Physiological Needs

phases of recovery in a disaster situation
Phases of Recovery in a Disaster Situation
  • Impact
  • Heroic
  • Honeymoon
  • Inventory
  • Disillusionment
  • Reconstruction
slide17
Assignment

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

What would have helped?

activity 1 disaster charades
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.
psychological first aid
Psychological First Aid

Protect

Direct

Connect

slide21

Summary of Basic Principles of Psychological First Aid:

Protect + Direct + Connect

  • Contact and engagement
  • Safety and comfort
  • Stabilization
activity 2 psychological first aid
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
protect direct connect

Summary of Basic Principles of Psychological First Aid:

Protect +Direct + Connect
  • Information gathering: current need and concerns
  • Practical assistance.
protect direct connect1
Protect + Direct +Connect

Summary of Basic Principles of Psychological First Aid:

  • Connection with Social Supports
  • Information on Coping
  • Linkage with Collaborative Services
do s of psychological first aid
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.

don ts of psychological first aid
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

Crisis

• Distinct From Trauma & Disorder

• Turning Point

• Momentous Decision

• Danger and Opportunity

goals of crisis intervention

Goals of Crisis Intervention

Enhance Opportunities

Stabilize

Reduce Dangers

steps in crisis intervention
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
basic skills of crisis intervention
Basic Skills of Crisis Intervention
  • Active listening
  • Reflecting
  • Normalizing
  • Prioritizing
  • Assessment
  • Stress management
  • Holding the bucket
holding the bucket
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?)
luv triangle listen
LUV Triangle: Listen

• Face and give the person your undivided attention.

• Lean toward the person and make eye contact.

luv triangle understand
LUV Triangle: Understand

• Repeat or paraphrase what the person is saying.

• Check your understanding.

understanding and responding
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 ……
luv triangle validate
LUV Triangle: Validate

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

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

activity 3 part 1
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.
activity 3 part 1 process recall
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?
activity 3 part 2 listening when emotionally loaded
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?
activity 3 part 2 process recall
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?
slide45
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?”
crisis intervention1
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
activity 4 crisis intervention
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
indicators for referral to professionals
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)
exercise referrals
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?
special considerations
Special Considerations

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

self care as a responder
Self Care As a Responder
  • Use the buddy system
  • Take breaks; Rotate shifts
  • Monitor your own stress level
putting it all together
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?
conclusion
Conclusion
  • Final Questions
  • Please complete class evaluations
  • Thank You for Coming!