Crisis Counseling Assistance and Training Program Transition to Regular Services Program Training

1. Crisis Counseling Assistance and Training ProgramTransition to Regular Services ProgramTraining

2. Objectives • After training, participants will be able to: • Identify ISP-to-RSP transition issues. • Define the goals and objectives of the RSP. • Identify ongoing and emerging disaster reactions related to transition. • Review crisis counseling services related to transition. • Practice crisis counseling skills for transition. • Complete data collection forms. • Update strategies for managing stress.

3. Table of Contents • Section 1—Transition from ISP to RSP • Section 2—Disaster Reactions Related to Transition • Section 3—Crisis Counseling During Transition • Section 4—Data Collection and Program Evaluation • Section 5—Stress Management • Section 6—Team Building

4. Section 1—Transition from ISP to RSP • Goals and Objectives of the RSP • Administrative Issues • Program Management Issues • Program Services Issues

5. Goals and Objectives of the RSP • In transition training it is important to emphasize: • Services of lower intensity and higher volume. • Ongoing needs assessment for this particular disaster and program. • Moving from basic, supportive to community and strengths-based counseling. • Continued identification of at-risk populations.

6. Goals and Objectives of the RSP (cont.) • In transition training it is important to emphasize (cont.): • Broader outreach to target populations. • Increased community networking. • Thorough assessment and referral. • Maximization of resource linkage. • Preparation of the community to rely on resilience and existing resources.

7. Goals and Objectives of the RSP (cont.) • In transition training it is important to emphasize (cont.): • Development of a thorough training plan that includes stress management. • Use of program data to adjust the CCP. • More detailed and comprehensive quality assurance. • Development and use of legacy materials. • Preparation of the community for the eventual phasedown of the CCP.

8. Administrative Issues CCP typical timeline:

9. Administrative Issues (cont.) RSP grant administration partnerships:

10. Program Management Issues • These components should be considered in relation to the transition to RSP: • Needs assessment and outreach strategy • Staffing plan • Training • Supervision and team meetings • Crisis counseling services

11. Program Management Issues (cont.) • These components should be considered in relation to the transition to RSP (cont.): • Stress management • Fiscal management • Quality assurance • Data collection and evaluation • Program media and marketing

12. Program Services Issues • Survivors’ reactions will change over time, resulting in the need for programmatic changes in the RSP. • There may be an increased need and opportunity for group crisis counseling and public education. • Survivors may experience deepened anxiety or depression as the new reality of life after disaster sets in. • While every disaster is different, there are some reactions that can be anticipated.

13. Section 2—Disaster Reactions Related to Transition • Key Concepts • Individual Reactions • Collective Reactions • Resilience

14. Key Concepts • Everyone who experiences a disaster is affected by it in some way. • People pull together during and after a disaster. • Stress and grief are common reactions to uncommon situations. • People’s natural resilience will support individual and collective recovery.

15. Key Concepts (cont.) • Typical outcomes of disaster: • Some will have severe reactions. • Few will develop diagnosable conditions. • Most do not seek treatment. • Survivors often reject help.

16. Key Concepts (cont.) Risk Factors-Population Exposure Model: • Injured survivors, bereaved family members • Survivors with high exposure to disaster trauma, or evacuated from disaster zone • Bereaved extended family and friends, first responders • People who lost homes, jobs or possessions; people with preexisting trauma; at-risk groups; other disaster responders • Affected people from community at large Adapted from DeWolfe, 2002.

17. Key Concepts (cont.) • Two types of trauma: • Individual trauma: • May cause stress and grief. • May cause fatigue, irritability, hopelessness, and relationship conflicts. • Collective trauma: • May damage community support. • May affect individual coping.

18. Individual Reactions • Types of individual reactions: • Physical • Emotional • Cognitive • Behavioral

19. Individual Reactions (cont.) • Anticipated reactions over time might include: • Anger around the limits of governmental assistance and insurance (e.g., “the system,” “red tape”). • Increased substance use. • Evolution of unaddressed trauma into diagnosable conditions such as posttraumatic stress disorder (PTSD) or depression. • Stress from financial hardship as resources run out. • Frustration and disillusionment at the pace of repairs. • Continued anxiety around dislocation and separation.

20. Individual Reactions (cont.) • Spiritual beliefs influence how people make sense of the world: • Survivors may seek the comfort that comes from spiritual beliefs. • Spiritual beliefs will assist some survivors with coping and resilience. • Survivors may question their beliefs and life structure.

21. Individual Reactions (cont.) • The severity of reactions is affected by the type of, level of exposure to, and casualties associated with the disaster. • Pre-existing trauma may increase the risk of severe reactions. • CCP staff members identify and refer for treatment anyone experiencing severe reactions. • Pre-existing levels of support will affect the severity of reactions.

22. Individual Reactions (cont.) • Severe reactions: • How do you recognize when a reaction becomes severe? • When does a severe reaction warrant referral?

23. Individual Reactions (cont.) • Disorders that may result from severe reactions: • Depressive disorders • Suicidal behavior • Substance abuse • Acute stress disorder • PTSD • Dissociative disorders • Anxiety disorders • Paranoia • Social isolation

24. Collective Reactions • Typical phases of disaster: • Pre-disaster phase • Impact phase • Heroic phase • Honeymoon phase • Disillusionment phase • Reconstruction phase

25. Collective Reactions (cont.)Typical phases of disaster (cont.): Adapted from CMHS, 2000.

26. Resilience • What is resilience? • Resilience is an ability to recover from or adjust easily to misfortune or change. • Merriam-Webster Online Dictionary

27. Resilience (cont.) • Factors affecting resilience: • Life situation • Individual traits and coping styles • Disaster and trauma experience • Family and social support • Spiritual beliefs • Presence of perceived control, and hope • Availability of accurate information • An effective and caring emergency response

28. Resilience (cont.) • To foster resilience, crisis counselors should assist survivors in: • Making realistic plans and taking the steps to carry them out. • Maintaining a positive self-image and confidence in their own abilities. • Accessing their skills in communication and problem solving. • Managing strong feelings and impulses. Adapted from The Road to Resilience, American Psychological Association (2006). www.apa.org

29. Resilience (cont.) • Ten ways survivors can build resilience: • Make connections. • Avoid seeing crises as insurmountable problems. • Accept change as a part of living. • Move toward your goals. • Take decisive actions. • Look for opportunities for self-discovery. • Nurture a positive view of yourself. • Keep things in perspective. • Maintain a hopeful outlook. • Take care of yourself. Adapted from The Road to Resilience, American Psychological Association (2006). www.apa.org

30. Resilience (cont.) • Personal growth can occur as a result of surviving disaster. • Examples of personal growth include: • Becoming closer to loved ones. • Having faith in the ability to rebuild one’s life. • Becoming more spiritual or religious. • Finding a deeper meaning and purpose in life. • Discovering inner strength. Kessler et al., 2006

31. Section 3—Crisis Counseling During Transition • Where Are We Now? • Where Do We Go from Here?

32. Where Are We Now? • How is your program: • Strengths based? • Culturally competent? • Diagnosis free? • Community based? • Outreach oriented?

33. Where Are We Now? (cont.) • How does your program: • Bolster community support systems? • Assume natural resilience and competence?

34. Where Are We Now? (cont.) • How do crisis counselors assist people to: • Understand their situations and reactions? • Regain a sense of mastery and control? • Identify, label, and express emotions? • Adjust to the disaster and losses? • Manage stress? • Make decisions and take action? • Develop coping strategies? • Use community resources?

35. Where Are We Now? (cont.) • Outreach: • What populations have you targeted? • What have your outreach strategies been? • How successful have these strategies been?

36. Where Do We Go from Here? • Ongoing needs assessment: • What populations were not reached? • What new populations need to be targeted? • What strategies are we going to use?

37. Where Do We Go from Here? (cont.) • What can be done in the following areas to develop culturally competent programming? • Staff • Program • Community

38. Where Do We Go from Here? (cont.) CCP reach of services:

39. Where Do We Go from Here? (cont.) • All services are provided throughout the CCP, however: • Higher intensity, lower volume services are typically done in the ISP. • Lower intensity, higher volume services are done in the RSP. • Group-oriented services are important in the RSP.

40. Where Do We Go from Here? (cont.) • At-risk populations: • What services have been most effective with specific at-risk populations? • What service needs remain? • How will the program deliver needed services?

41. Where Do We Go from Here? (cont.) • Group crisis counseling is characterized by: • Services that help group members understand their current situations and reactions to the disaster. • A need that may increase later in the CCP as people are ready to connect with others. • Group members who should have had similar levels of exposure. • Participants gaining mutual support from other group members. • Psycho-education areas that include stress management, coping with triggers, expressing emotions, and problem solving.

42. Where Do We Go from Here? (cont.) • Support groups: • Are less structured than psychotherapy groups. • Increase the social support network. • Facilitate exchange of information on life situations. • Help develop new ways of adapting and coping. • Can be member facilitated.

43. Where Do We Go from Here? (cont.) • Self-help groups: • Are appropriately facilitated by a professional or paraprofessional crisis counselor. • Can be cofacilitated by a group member to encourage transition to a member-facilitated group process. • Are no longer a CCP service once the group has transitioned to a member-facilitated process.

44. Where Do We Go from Here? (cont.) • Psycho-educational groups: • Provide tools to obtain and process new information. • Usually have limited duration and scope. • Provide practical and concrete assistance. • Use handouts and factual information relevant to the group’s discussion. • Use speakers relevant to content area and group members’ needs.

45. Where Do We Go from Here? (cont.) • Practical concerns in group crisis counseling: • Assess your own knowledge and skills related to the content of the group. • Be aware of your own values, biases, and beliefs, and how these affect the group. • Respect and maintain confidentiality. • Facilitate—do not dominate—the conversation or the group. • Ask for feedback from the group. • Rappin & Kell, 1998.

46. Where Do We Go from Here? (cont.) • Community support and networking: • Promote familiarity with disaster relief resources. • Create a seamless system for referral. • Create opportunities for shared resources and training.

47. Where Do We Go from Here? (cont.) • Through community support and networking, the CCP: • Partners with community support systems. • Participates in community gatherings and rituals. • Reaches out to community groups and leaders. • Maintains a compassionate presence. • Bolsters, but does not replace, systems in place.

48. Where Do We Go from Here? (cont.) Typical partners:

49. Where Do We Go from Here? (cont.) • Community support and networking—other potential partners: • Emergency management • Law enforcement • Substance abuse prevention community • Office for Victims of Crime • Community-based cultural organizations • Native American tribal community leaders • Refugee organizations • Suicide prevention organizations • Mental health and substance abuse consumer groups

50. Where Do We Go from Here? (cont.) • Public education: • Can be informational and educational presentations and materials. • Is likely to increase during the course of the CCP. • Is designed to: • Build resilience. • Promote constructive coping skills. • Educate about disaster reactions. • Help people access support and services. • Leave a legacy of educational materials.