ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
September 7, 2001
"My interest is in the future...because I'm going to spend the rest of my life there."
- Charles Kettering
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CRITICAL INCIDENT STRESS WORKSHOP sponsored by The University of Wyoming Counseling Center
and The Rocky Mountain Region Disaster Mental Health Institute will be held in Laramie, WY
on November 16, 17, 2001. There will be two workshops. One will be in Basic Critical Incident
Stress Management (CISM) on 11/16-11/17 and will be a certification course taught by
International Critical Incident Stress Foundation (ICISF) certified trainers. The Advanced
Issues in Critical Incident Stress Debriefing will be taught by U.S. Navy Psychologist
CDR Bryce Lefever, PhD, ABPP. Enrollment in both workshops is limited. There is an early bird
registration period. If you wish to receive a printed brochure, please email:
larlion@hotmail.com with your name and mailing address.
Online Brochure can be accessed at: https://www.angelfire.com/biz3/news/cismuw.html
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RACE A FACTOR IN VOCATIONAL REHABILITATION SERVICES
White Americans with disabilities are more likely to be accepted for
vocational rehabilitation services than similarly disabled African
Americans, Native Americans, Alaskan Natives, Asians or Pacific
Islanders in the United States, according to a Penn State researcher.
"People with disabilities in the United States already have a jobless
rate of 70 percent, even though the great majority want to work. For
(them), a severe disability, whether physical or psychological, can
be compounded by race or ethnicity. Their predicament is aggravated
even more when they are female," says Keith B. Wilson, assistant
professor of rehabilitation in the College of Education. "A
contributing factor to this discrimination seems to be that there are
few vocational rehabilitation counselors and administrators who are
people of color." Wilson's findings were presented this summer at a
conference of the Australian Society of Rehabilitation Counselors and
will be published in the journal, Rehabilitation Counseling Bulletin.
For the full story by Paul Blaum, visit
http://www.psu.edu/ur/2001/accessrehabilitation.html.
MOST COLLEGE PROTESTERS ARE WELL ADJUSTED
Rather than being misfits, college protesters are more
likely to be socially active on campus and enjoy a wide
circle of friends and acquaintances, a Penn State
researcher says. These same peer networks seem to have
a more profound influence on student activism than
political ideology or any deep dissatisfaction with the
prevailing government, says Byeong Chul (Ben) Park,
assistant professor of human development and family
studies at the Penn State DuBois campus. "We found a
strong relationship between levels of extracurricular
involvement and student activism," he reported this
week at an American Sociological Association
conference. "It seems that those students who had
adjusted well to college life through engagement in
campus activities were more likely to participate in
protest movements than those who had not." This profile
is in contrast to a common perception that protesters
are alienated from the mainstream of college students.
Park's data are taken from 1,111 questionnaires
collected at 10 Korean universities. For the full story
by Paul Blaum, visit http://www.psu.edu/ur/2001/collegeprotestors.html.
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SELECTION AND TRAINING OF DISASTER MENTAL HEALTH PROFESSIONALS
A lot of the confusion and stress at the time of a disaster can be eliminated if a mental
health agency has predesignated and trained a core staff as a disaster response team. This
team should receive regular in-service training and participate in local disaster exercises
to help maintain and fine tune skills. Given the needed resources, this team can respond
to smaller crises that happen locally so that they will have first-hand experience behind
them should a large disaster occur.
SELECTING DISASTER MENTAL HEALTH PROFESSIONALS
Disaster mental health work is NOT for everyone. Mental health professionals should be
flexible and socially extroverted. Despite altruism and a sincere desire to help, NOT ALL
INDIVIDUALS ARE WELL-SUITED FOR DISASTER WORK. Below are some of the
different selection issues that should be considered.
Qualifications of disaster mental health professionals:
* In order to understand the important qualifications for disaster mental health professionals
it is necessary to appreciate that disaster mental health roles and responsibilities are
diverse. Because of this it is important to thoughtfully match worker skills and
personalities with the specific assignment. This helps to ensure the success of mental
health efforts.
* There are four major areas that disaster mental health professionals work in:
1. OUTREACH:
Working in neighborhoods, mass care shelters, disaster application centers or other
community settings requires workers who are adept at such nontraditional mental health
approaches as "aggressive hanging out", "mental health by walking around", and "over a
cuo of coffee" assessments and interventions.
2. PUBLIC EDUCATION
Public education efforts require professionals who are interested and effective in
public speaking and working with the media. Development of fliers and brochures require
writing skills.
3. COMMUNITY LIAISON
Establishing and maintaining liaison with community leaders requires professionals who
understand and are effective in dealing with organizational dynamics and the political
process. Working successfully in the "grass roots" community requires someone who
understands the local culture, social network, formal and informal leadership, and is
effective in establishing relationships at the neighborhood level. Liaison activities
might include everything from attending grange or church gatherings, participating in
neighborhood meetings, or providing disaster mental health consultation to government
officials.
4. CRISIS COUNSELING
For most disaster survivors, prolonged psychotherapy is not necessary or even appropriate.
Crisis intervention, brief treatment, support groups and practical assistance are most
effective. Mental health professionals must have knowledge and skills in these modalities:
* Ability to remain focused
* Be able to function well in confused, chaotic environments
* Must be able to "think on their feet," and have a common-sense, practical, flexible
and often improvisational approach to problem solving
* Be comfortable with changing situations, and able to function with role ambiguity,
unclear lines of authority, and a minimum of structure
* See problems as challenges rather than burdens
* Have initiative and stamina as well as self-awareness
* Ability to monitor and manage their own stress
* Be able to work cooperatively in a liaison capacity
* Be aware of and comfortable with value systems and life experiences other than their own
* have an eagerness to reach out and explore the community to find people needing help,
istead of a "wait and treat" attitude, is essential
* Enjoy people and not appear lacking in confidence
* Comfortable initiating a conversation in any community setting
* Willing and able to "be with" survivors who may be suffering tragedy and enormous
loss without being compelled to try to "fix" the situation.
* Have special skills to match the needs of the population, i.e. special expertise in
working with children and the local schools or if there are many elderly persons in
the community, the team should include persons skilled in working with older adults.
* Be sensitive to cultural issues and be familiar and comfortable with the culture of
the groups affected by the disaster
* Able to provide services that are culturally appropriate
* Be fluent in the languages o0f non-English speaking groups affected
* Ideally, mental health professionals should include individuals indigenous to specific
cultural groups affected by the disaster
* Be action oriented especially with the pace of crisis intervention
* Be able to handle the sights and sounds of physical trauma
* Be adept and creative
* Have patience, perseverance, and an ability to function without seeing immediate results
* Multidisciplinary and multi-skilled
* Experienced in psychiatric triage, first aid, crisis intervention, and brief treatment
* Have knowledge of crisis, post-traumatic stress and grief reactions
* Comfortable providing services in nontraditional community-based settings
* Be acquainted with the functions and dynamics of the community's human service
organizations and agencies
* Establish rapport quickly with people with diverse backgrounds
* Have excellent communication, problem solving, and conflict resolutions skills
DISASTER MENTAL HEALTH TRAINING
Effective disaster mental health training provides professionals with certain knowledge,
skills, and attitudes that will enhance their effectiveness in disaster settings. Because
involvement with disaster mental health work requires a perceptual shift from traditional
mental health delivery, the acquisition of new skills and information is essential.
Objectives of comprehensive disaster mental health training are to provide the participants
with the knowledge, skills, and attitudes that will enable them to:
* Understand human behavior in disasters
Effective factors affecting individuals' response to the disaster, phases of disaster,
"at risk" groups, concepts of loss and grief, postdisaster stress, and the disaster
recovery process.
* Intervene effectively with special populations in disasters
including children, older adults, people with disabilities, ethnic and cultural groups
indigenous to the area, and the disenfranchised or people living in poverty with few
resources.
* Understand the key concepts and principles of disaster mental health and how disaster
mental health services differ from traditional psychotherapy
including how disaster mental health services differ from traditional psychotherapy; the
spectrum and design of mental health programs needed in disaster; and appropriate sites
for delivery of mental health services.
* Provide appropriate mental health assistance to survivors and workers in community
settings
in community settings, with emphasis on crisis interventions, brief treatment, post-
traumatic stress strategies, age-appropriate child interventions, debriefing, group
counseling, support groups, and stress management techniques.
* Provide mental health services at the community level
with emphasis on case finding, outreach, mental health education, public education,
consultation, community organization, advocacy, and use of the media.
* Understand the stress inherent in disaster work and recognize and manage that stress
for themselves and with other workers
ORIENTATION BRIEFINGS
In addition to training, it is important to provide an orientation to the disaster for
mental health professionals prior to deployment. The following topics should be covered:
Status of the Disaster
nature of damages and losses, predicted weather or condition reports, boundaries of
impacted area, hazards, response agencies involved.
Orientation to the Impacted Community:
demographics, ethnicity, socioeconomic makeup, pertinent politics, etc.
Community and Disaster-related Resources:
handouts with brief descriptions and phone numbers of human service and disaster-related
resources. FEMA or the state Office of Emergency Management usually provides written fliers
describing state and federal disaster resources once Disaster Application Centers (DACs) are
opened. If available, they should be provided to all workers. Provide workers information
outlining normal reactions of adults and children, ways to cope, and where to call for help.
Logistics
arrangements for workers' food, housing, obtaining messages, medical care, etc.
Communication
how, when, and what to report through the mental health chain of command; orientation to
use of cell phones, two-way radios, or amateur radio volunteers, if being used.
Transportation
clarify mode of transportation to field assignment. If workers are using personal vehicles,
provide maps, delineate open and closed routes, indicate hazard areas.
Health and Safety in a Disaster Area:
outline potential hazards and safety strategies (e.g., protective action in earthquake
aftershocks, flooded area, etc.). Discuss possible sources of injury and injury prevention.
Discuss pertinent health issues such as safety of food and drinking water, personal
hygiene, communicable disease control, disposal of waste, and exposure to the elements.
Inform of firstaid/medical resources in the field.
Field Assignments:
outline sites where workers will be deployed (shelters, meal sites, etc.). Provide brief
description of the setup and organization of the site and name of the person to report to.
Provide brief review of appropriate interventions at the site.
Policies and Procedures
briefly outline policies regarding length of shifts, breaks, staff meetings, required
reporting of statistics, logs of contacts, etc. Give staff necessary forms.
Self-care and Stress Management
encourage the use of a "buddy system" to monitor each other's stress and needs. Remind
of the importance of regular breaks, good nutrition, adequate sleep, exercise, deep
breathing, positive self-talk, appropriate use of humor, "defusing" or talking about
the experience after the shift is over. Inform workers regarding debriefing to be
provided at the end of the tour of duty.
SUMMARY
The mix of counselors needed in disaster recovery programs changes with each stage of
disaster. during the heroic and honeymoon stages the basic skill required of counselors
is crisis intervention along with an understanding of the psychological reactions to
disaster, phases of disaster, key concepts of disaster, the disaster recovery model
and needs of target populations. Successful disaster recovery counseling programs are
those which:
1. Are re-invented at each phase of the disaster;
2. Locate vulnerable populations and target tailored programs to that population; and
3. Employ the complete range of strategies including:
* recovery education;
* skillbuilding and natural group interventions;
* mobilizing community resources to meet survivors' needs
* direct interventions, including crisis intervention, active case management and
disaster recovery counseling, and
* community organization
At each phase of disaster for each target population the full range of strategies
should be employed.
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REFERENCES
Ahearn, F.L., Jr. & Cohen, R.E. (1984). Disasters and Mental Health: An annotated
bibliography (DHHS Publication No. ADM 84-1311). Rockville, MD: Center for Mental
Health Services (formerly national Institute of Mental Health).
Farberow, N.L. (1978a). Field manual for human service workers in major disasters (DHHS
Publication No. ADM 78-537). Rockville, MD: CMHS (formerly NIMH).
Farberow, N.L. (1978b). Human problems in disasters: A pamphlet for government emergency
disaster services personnel (DHHS Publication No. ADM 78-539). Rockville, MD: CMHS (formerly
NIMH).
Farberow, N.L. (1978c). The media in a disaster (DHHS Publication No. ADM 78-540).
Rockville, MD: CMHS (formerly NIMH).
Farberow, N.L. (1978). Training manual for human service workers in major disasters
(DHHS Publication No. 83-538). Rockville, MD: CMHS (formerly NIMH).
Farberow, N.L. (1981). Manual for child health workers in major disasters (DHHS
Publication No. ADM 81-1070). Rockville, MD: CMHS (formerly NIMH).
Flynn, B. (1987). Returning home following disaster work. In Prevention and control of
stress among emergency workers: A pamphlet for team managers (DHHS Publication No. ADM
90-1497, pp. 6-9). Rockville, MD: CMHS (formerly NIMH).
Garrison, jean (1979). Workbook for developing an application for crisis counseling
services for disaster victims (NIMH & FEMA).
Hartsough, D.M. (1985). Stress and mental health interventions in three major disasters. In
D.M. Hartsough & D.G. Myers (Eds.), Disaster work and mental health: Prevention and
control of stress among workers (DHHS Publication No. ADM 85-1422, pp. 1-44). Rockville,
MD: CMHS (formerly NIMH).
heffernan, W. & Heffernan, J.B. (1986). When farmers have to give up farming. Rural
Development Perspectives, 2,3,10-14.
Heffron, E.F. (1977). Project outreach: Crisis intervention following natural disaster.
Journal of Community Psychology, 5,103-111.
Lebedun, M. & Wilson, K.E. (1989). Planning and integrating disaster response. In
R. gist & B. Lobin (Eds.), Psychological Aspects of Disaster. New York: John Wiley and Sons.
Lystad, M. (Ed.). (1985). Innovations in mental health services to disaster victims
(DHHS Publication No. ADM 85-1390). Rockville, MD: CMHS (formerly NIMH).
Myers, D. (1994). Disaster response and recovery: A handbook for mental health professionals.
Washington, D.C.: United States Department of Health and Human Resources, Public Health Service.
Myers, D.G. (1985). helping the helpers: A training manual. In D.M. Hartsough & D.G. Myers
(Eds.), Disaster Work and Mental Health: Prevention and Control od Stress Among Workers
(DHHS Publication No. ADM 85-1422, pp. 45-149). Rockville, MD: CMHS (formerly NIMH).
National Institute of Mental Health. (1985). Role stressors and supports for emergency
workers (DHHS Publication No. ADM 90-1408). Rockville, MD: NIMH.
National Institute of Mental Health. (1988a). Prevention and control of stress among emergency
workers: A pamphelt for team managers (DHHS Publication No. ADM 88-1496). Rockville, MD: NIMH.
National Institute of Mental Health. (1988). Prevention and control of stress among emergency
workers: A pamphlet for workers (DHHS Publication No. ADM 88-1497). Rockville, MD: NIMH.
Tierney, K.J. & Baisden, B. (1979). Crisis intervention programs for disaster victims: A
source book and manual for smaller communities (DHHS Publication No. ADM 83-675).
Rockville, MD: NIMH.
Weaver, J.D. (1995). Disasters: Mental Health Intervention. Sarasota, FL: Professional
Resource Press.
To search for books on disasters and disaster mental health topics and purchase them online,
go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
