9. Direct relation with the incidentOther than certain exceptions, only the people who had a direct relation with the incident are eligible.
10. Pay attention to certain needs
People who smoke can do so providing the other participants do not object.
11. No interference
"Pagers", including those belonging to the group leaders, must be turned off or placed on vibrate.
12 Respect of the group's privacy
Taking notes, or recording the session on tape, as well as the presence of media people are prohibited.
13. Pay attention to the silent participants
Attention must be paid to the people who do not speak but who seem to be disturbed. They can be approached privately later on, in the event that they are simply individuals who are reticent to express themselves in front of a group.
Organizational Aspects
The Optimal Intervention Should:
Be Held:
as soon as possible following the appearance of symptoms (idea of "immediacy");
as close as possible to the site of the disaster or the place to which the disaster victims were evacuated (idea of "proximity").
Bring together:
similar groups (idea of "community").
Create:
a favorable climate which allows the message to be heard.
Whatever the people are experiencing is normal. They can recover from it and they will be able to return to their activities (idea of "expectancy").
It is also important to take into account:
The Composition Of The Group:
In order to encourage discussion, the composition of the group should be homogenous. The characteristics of the participants must be taken into account: primary clientele, secondary clientele and tertiary clientele and, if possible, age groups.
Who should be grouped together in an incident debriefing session?
Anyone associated with a traumatic incident can participate in a debriefing session. The issue is: who should be grouped with whom?
A. Debrief those in the greatest need first.
Picture a target with concentric circles. The closer you are to the center, the more directly or more closely involved you were with the incident. Set your priorities so that those closest to the center get debriefed first.
In this way, you ensure your energies go to those in greatest need. You have only so much energy and so many resources. Use them wisely.
B. Debrief homogenous groups
For debriefings to work, individuals need to feel safe. Debrief those who were present at an incident or those who witnessed one separately from those who did not. Those who were present at an incident often feel uncomfortable when people who were not directly involved in the incident participate. As well, details mentioned during a session could unnecessarily traumatize those who were not there. One way to ensure this is to debrief at a peer level. This means excluding one's superiors or subordinates.
As well, when debriefing disaster service groups, it is important to ensure that they are professional equals. For example, professional firefighters, ambulance attendants and police officers can be debriefed in the same group. However, the session may not work if others not of similar professional status, such as volunteer workers or highways staff, were present. You must know your group and make your own decisions.
The Significant Person For The Group:
This person is recognized or identified as being helpful and significant for the group.
The Number Of Participants:
A group should be restricted to a maximum of twelve participants, or less if the emotional load is extremely heavy.
The Climate
The meeting must take place in a favorable atmosphere of support and understanding. Each person's reactions are offered to the group and accepted.
A BASIC RULE: No one is allowed to criticize someone else.
Information sessions presented jointly with the organizations involved are intended for the whole community. They consist of providing general information and dealing briefly with the current difficulties, the reactions that may be shown by the victims, services available, and the problems typically associated with returning to normal life. The activities suggested for information sessions are all optional. None are mandatory, neither for the disaster victims nor for the members of their families or witnesses of the event.
During these information sessions, the following messages are among those given with regard to physical and emotional reactions:
the physical and emotional symptoms are part of a stress reaction and are considered normal;
these symptoms occur in most people in a situation of stress, threat or loss. They are primitive reactions of the mind and body, and their purpose is to help the individual survive;
stress syndromes, although normal, can, however, present health risks if they persist, since they rob people of energy and make them vulnerable to illness. In some cases, they can even have repercussions on a person's whole life;
there are many ways of dealing with stress reactions, such as surrounding oneself with people one feels good with and with whom it is easy to talk about what one is experiencing, doing vigorous physical exercise, or using relaxation techniques.
the most effective way of relieving stress reaction syndrome is verbalization sessions on the event.
Verbalization Sessions
Verbalization sessions on the event are a simple but effective method of
assisting the population and responders to cope with and carry on with normal life.
A verbalization session on the event usually permits the alleviation of acute stress
reactions in order to reduce or prevent delayed stress reactions.
This method is a rational way of dealing with stress reactions. The intervention
model focuses on THREE specific objectives:
to help people express their feelings;
to assist them in understanding their emotional reactions and their behavior;
to promote a return to a state of equilibrium in each individual.
The specialized literature in this area suggests that this type of intervention gives
very good results if it takes place quickly after the disaster or tragedy, that is between
24 and 72 hours following the event. At least 24 hours should be allowed to elapse
before such a session, since the normal mechanisms of denial and avoidance are
predominant immediately after the disaster, whereas after 24 hours, cognitive activity
decreases to give way to feelings and emotions. Studies have shown the importance
of holding these sessions promptly, because the longer one waits to carry out post-
disaster intervention, the less effective is the intervention. Therefore it is important
that it take place within 72 hours.
The optimal intervention should take place as soon as possible after the appearance
of symptoms (the concept of immediacy) and as close as possible to the site of the
disaster or the evacuation site of the disaster victims (the concept of proximity). It
should bring together similar groups (the concept of community) and create a
climate that carries a clear message: what they are experiencing is normal; it can
be healed and they will be able to resume their activities (the concept of expectancy).
The make-up of the groups should be homogeneous and reflect the characteristics
of the participants - men, women, the elderly, adolescents, responders, etc. - in order
to facilitate discussion.
Groups should be restricted to a maximum of 12 participants, or fewer if there is too
great an emotional charge. The atmosphere should be positive, supportive and
understanding. The reactions of each participant are shared and accepted. The
basic rule is that no one criticizes another person.
The verbalization sessions on the event should be led by competent mental health
professionals who are knowledgeable about this type of intervention and who have
received the necessary training.
It is important to demystify psychological help because it is too often confused with
mental problems. It is essential that psychological help be offered and that it be
offered at the time of the tragedy because people need to verbalize their emotions
and be together to comfort each other.
Follow-up, Referral to Mental Health Resources, Counseling
Each organization should have some means of monitoring individuals' recovery from traumatic events or incidents. This may take place as a routine follow-up meeting (group or individual) with the debriefing facilitator,
a meeting between supervisor and employee, or a routine medical check with the employee health nurse
or physician. The purpose of the follow-up is to allow the worker further opportunity to talk about feelings
about the incident. It is also to assess with the individual whether the symptoms are diminishing. A good
time to do a routine follow-up is about a month to 6 weeks following the event.
If workers are still having difficulties with stress symptoms at that time, a routine referral to a mental health counselor
should be suggested. The organization should have a pre-established plan for referrals to counselors who
are knowledgeable or specialize in working with emergency service personnel. Fee arrangements should
be pre-established. The ideal arrangement is for mental health services to be available to emergency
workers through their prepaid employee health plan or EAP. Many plans do not provide this coverage.
Personnel are often angry if they find they must pay for counseling out of their own pocket when the trauma
was a work-related event. This can produce a real barrier to personnel obtaining the services they need to
remain functional and productive on the job.
Sometimes workers are unfamiliar with the process of counseling and what it entails and are therefore reluctant to
seek help. They should know that most counselors prefer to work with emergency workers in a short-term,
active approach. Counselors often use specific techniques which are aimed at symptom reduction. They
usually do not use long-term, psychoanalytic approaches. Occasionally, depending on the nature of the
problem, marital or family therapy may be suggested.
Post-disaster Counseling for Individuals or Groups
Counseling should be offered to individuals who were unable to attend a verbalization session or debriefing.
Counseling can also be offered to people who feel a need for individual help or for longer term help in
a group.
This type of intervention usually consists of two or three meetings during which the counselor pursues the same
objectives as during the verbalization session. In terms of the content, essentially the same techniques
developed in the Mitchell Model seem to be effective. The major difference is that they are spread out
over time rather than being concentrated in a single session.
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