ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER

Learning From The Past and Planning For The Future


MENTAL HEALTH MOMENT
September 21, 2001

"Failure is the opportunity to begin again, more intelligently."
- Henry Ford


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PSU ACOUSTIC SPECIALISTS LISTEN FOR LIFE IN NY RUBBLE

 A team of four Penn State acoustic specialists began
 working with other rescue teams early Monday morning
 (September 17) to attempt to apply specialized acoustic
 technologies to assist in locating survivors in the
 debris at the scene of the World Trade Center tragedy
 in New York City. Anthony Atchley, professor and head
 of the graduate program in acoustics; Thomas B.
 Gabrielson, senior research associate in the Applied
 Research Laboratory; Thomas Donnellan, associate
 director for materials and manufacturing in the Applied
 Research Laboratory; and Matthew Poese, graduate
 student in acoustics, are using ultrasensitive
 electronic microphones in the search. The team hopes
 that the microphones and support equipment, which they
 brought with them from the University, will enable them
 to detect and analyze sounds in the World Trade Center
 complex sub-structure and determine whether the sounds
 are being made by survivors or are the result of other
 sources. For more on how Penn State is lending its
 hearts and hands to the victims of last week's tragedy,
 visit http://www.psu.edu/ur/flash.
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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@callatherapist.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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OUTREACH TECHNIQUES AND RECOMMENDATIONS

These outreach techniques and recommendations include concrete, specific suggestions for
mental health workers following a disaster.

Casefinding and Outreach to Individuals

Always and in all places, mental health staff should informally be collecting 
information that will help them to locate disaster survivors. They should make every
effort to get the survivor's original address, current address, phone number, and message
phone.

A useful approach is to obtain lists with names and addresses of survivors. Such lists
may be available through FEMA, the Red Cross, Social Services, hospital emergency rooms,
the coroner's office, Department of Public Works, the building permit department, the
Chamber of Commerce, the Unemployment Department (Disaster Unemployment Assistance), and 
newspaper/media reports. Some of these groups may consider their lists to be confidential,
but it is worth a persistent try. Education of the agencies about the importance of outreach 
and education may help. Reassurance that the lists will only be used for outreach conducted
by the FEMA crisis counseling program is important. These lists can be used for sending
outreach letters with brochures from the mental health recovery project. Such mailings can
list common reactions to disaster, self-help suggestions, and the project's phone number.
The lists can also be used for making outreach telephone calls or home visits.

Use of door-to-door visits can be one of the most effective outreach techniques. It is
helpful for staff to work in pairs, because knocking on doors is often a foreign approach
for mental health workers. It may feel uncomfortable at first. In addition, the work can
be discouraging for staff if people are not immediately receptive. A male-female team can
alleviate suspicions as to motive of the team or safety for the resident (DeWolfe, 1992).

Following up a mailing provides a good "in". DeWolfe (1992) has illustrated how a mental
health worker might approach going door-to-door or making a follow-up phone call. Workers
can start out by asking if the person has received the mailing describing the program.
Another way of starting is to say something like "Hi, I'm John Jones from Flood Support
Services and I understand that you were hit real hard by the floods right here. Do you
have time to talk?" After that, the worker can go with whatever the person says first
after the introduction. If it's anger about the flooding, then the worker can agree and
support the person's anger and frustration. If it's children tearing up the house, the
worker can talk about the challenges of parenthood. After establishing rapport, the
subject of damages in the disaster can be discussed. "Can you tell me what happened? 
Did you have mud in your house? How deep was the water?" In the resulting discussion, 
the worker can assess how the person is coping and what their needs might be. 

DeWolfe (1992) has also observed that people are often more comfortable talking about
how others are doing at first. Ask what kinds of stress reactions they see in the
neighborhood. Ask how their children are doing. These are good openers to begin 
talking about psychological reactions and family coping. 

Provide brochures and information about common reactions and things that can be helpful,
as well as phone numbers of the mental health disaster recovery project and other resources.
Ask them to pass the information along to anyone who may need it. 

Identify people in the community who will be familiar with the needs in the community,
and can serve as "key informants". These informants may be found in:

* key agencies and groups in affected neighborhoods (health, social services, churches,
  schools, daycare providers, community groups, police, fire department, etc.);

* places where people congregate (thrift shops, restaurants or coffee shops, bars, 
  grocery or liquor stores, etc.);

* other services familiar with the neighborhood (mail delivery personnel, public 
  utility workers, building inspectors); and

* businesses or offices that survivors frequent during their recovery (thrift shops,
  lumber yards, hardware stores, building permit departments).

Different people will emerge as key informants depending on the type of disaster and
the phase of disaster. In early phases, such people may include Federal Emergency
Management Agency (FEMA) and Red Cross workers, insurance adjusters, managers at hotels
where survivors are temporarily living, demolition contractors, etc. Later, as
people begin rebuilding, there will be planning department staff who issue permits,
engineers, architects, contractors, building supply stores, etc. Still later, as 
rebuilding nears completion, survivors will be interacting with building inspectors,
furniture stores, landscapers, and the like.

Key informants related to the type of disaster might include fire departments (wildfires),
structural engineers (earthquakes), flood control engineers (floods), geologists 
(landslides), and the like.

Request an interview with key informants to find out the following: How do they see the 
stress level in this neighborhood? Are there any specific concerns they have? Are there 
any specific individuals or families they are concerned about?

Workers should make regular visits to places where survivors may congregate, such as 
senior centers, recreation halls, food kitchens, etc. Community meetings are a good
place to meet survivors. By "aggressively hanging out" workers can strike up 
converesations and actively make connections with individual survivors.

Providing Outreach to the General Community

Outreach to the community has two goals:

1. Public Education aimed at helping the population to realize that most stress
   reactions they are experiencing are normal, and providing suggestions about how to
   reduce/cope with disaster related stress.

2. Resource Information about services that are available and where to call for help.

Effective community outreach strategies include:

1. Newspapers and Community Newsletters: articles, interviews, human interest stories,
   paid advertisements.

2. Radio and Television: public service announcements; special programs on effects of
   disaster; interviews with mental health staff, community leaders, or disaster survivors;
   human interest stories; call-in shows.

3. Public Speakers: to civic groups, service clubs, special interest groups, PTAs,
   churches, etc.

4. Videotapes: for training and as an adjunct to public speaking, to educate the
   public and to stimulate discussion.

5. Posters: on bulletin boards, buses, bus stops, in clinics, waiting rooms,
   other public places.

6. Brochures and Fliers: handed out door-to-door, hung on doorknobs, in grocery bags,
   liquor stores, thrift stores, places where survivors do business, literature racks in
   clinics and doctors' offices, in government offices, in church bulletins, Scouts handing
   them out on the street, etc. Caregivers, agencies, and departments with whom survivors
   have contact can be given brochures and asked to hand them out. Door-to-door distribution
   of handouts providing public health information or mental health information on stress   
   management will often provide an opportunity to asses levels of emotional distress and
   provide information or intervention.

7. Books: especially for children, combining information about the cause of the
   disaster and ways to be safe; coloring; stories; games. 

8. Community Fairs and Events: information booths at fairs and festivals; games and
   activities for children and adults; pencils or balloons with recovery project logo and
   phone number.

Mental Health Training

The purpose of mental health training in the community is to increase awareness within the 
community of the mental health aspects of disaster recovery. This can generate a "ripple 
effect" and maximize the mental health knowledge and skills available in the recovering
community. Training also develops skills, instills confidence, fosters collaboration, 
and creates involvement in the mental health efforts toward disaster recovery. Training
can be provided to mental health, human service professionals, and other community
caregivers.

In addition, citizens who provide a support system for survivors can benefit greatly from
education about the mental health aspects of disaster recovery. These individuals include
relatives, friends, and neighbors. They often lack knowledge of common phases of recovery,
issues being dealt with in each phase, and normal stress and grief reactions. People are
often unsure about when and how to offer their support. Friends of survivors often subscribe
to some commonly held myths about trauma and loss: "Talking about it just keeps it all
stirred up." "It's time to put the past behind you and get on with your life." "Dwelling
on it is morbid." Education about the process of recovery and how best to support survivors
can strengthen the contribution of the informal support system to the healing process.

Target groups and suggested topics for training include:

1. Mental health professionals not involved in the disaster recovery project, but who
   may be seeing survivors in their practice

   Suggested topics include:

   a. Understanding disaster behavior and recovery

      * definition of disaster

      * myths and realities of human behavior in disaster

      * factors affecting the psychological response of individuals and the community to disaster

   b. Key concepts of disaster mental health

   c. Special populations in disaster: children, older adults, people with disabilities,
      specific ethnic groups

   d. Clinical issues and interventions:

      * symptomatology and assessment of post-traumatic stress and grief

      * stress management and self-help approaches

      * crisis intervention/brief treatment

      * support groups

   e. Disaster assistance resources/agencies

2. Human service professionals and other caregivers

      * social services, child and adult protective services

      * human needs centers

      * special population programs (older adults' services, drug and alcohol programs,
        parenting programs, services for specific ethnic groups, etc.)

      * health services (physicians, nurses, public health and school nurses, emergency
        room personnel, emergency medical technicians and paramedics)

      * schools, preschools, daycare providers, foster parents

      * clergy

      * police and fire department personnel

      * disaster agencies: FEMA, Red Cross, Salvation Army, other voluntary agencies in
        disaster

      * "natural helpers"

Suggested topics include:

   a. Understanding disaster and disaster recovery

   b. Special populations in disaster (children, older adults, disabled, ethnic populations)

   c. Disaster stress symptomatology: normal reactions, and when and where to refer

   d. Helpful skills and styles of relating to disaster survivors (listening, problem
      solving, crisis intervention)

   e. Self-help and stress management skills for disaster survivors

   f. Recovery resources

3. Citizens who serve as support networks for disaster survivors (friends, relatives, 
   neighborhood groups, church groups, etc.)

   Suggested topics include:

   a. Phases of disaster recovery and common issues, stressors, and needs in each phase

   b. Ways to help: listening skills; what to do and say that can be helpful

   c. Resources and referrals: when, how, and where to refer

Consultation

Consultation to community caregivers and agencies has a goal similar to that of training.
The purpose is to increase awareness of the mental health facets of disaster recovery,
and expand the mental health knowledge and skills available to survivors in the community.

The goals of consultation are:

1. To facilitate the work of other professionals and caregivers in the mental health aspects
   of helping disaster survivors.

2. To encourage other professionals, caregivers, and programs to incorporate mental health
   principles and approaches into their services.

3. To assist other professionals and caregivers in linking disaster survivors with
   appropriate resources, including mental health.

Cohen and Ahearn (1980) emphasize that mental health must first establish trust and 
collaboration with agencies to whom it will be consulting. Consultants need to understand
the mission and methods of the agency or individual to whom they are providing consultation,
and not threaten existing methodology. It is helpful if mental health accepts referrals
without delay. It is also important to work out unrealistic expectations or perceptions
of what mental health can do.

Consultation can be of two types (Cohen and Ahearn, 1980):

1. Case-oriented: case consultation involving a mental health professional assessing
   a client or providing consultation about a client to a worker.

2. Program-oriented: consultation aimed at influencing programs, administrative
   structures, and staff. Goals include early detection and intervention with mental
   health problems, increased coordination and linkage among programs, decreased
   fragmentation of services, and making services as responsive to needs of disaster 
   survivors as possible. Issues addressed in program oriented consultation will probably
   include such topics as program design and planning; administrative structures; methods
   of service delivery; policies and procedures; and recruitment and training of staff.

Community Organization

Community organization is the process of bringing together community members for defining
and working to solve their own problems (Ross, 1967; Taillie, 1969). Issues may include
social policy in disaster reconstruction, disaster preparedness at the neighborhood level,
or other issues of neighborhood concern.

While the content around which people organize may not be the usual arena for 
mental health, the process is uniquely tailored to help disaster recovery in the
following ways:

1. It can help people deal with concrete problems of concern to them.

2. It can re-establish feelings of control, competence, self-confidence, and effectiveness
   that were weakened by the disaster.

3. It can establish, re-establish, or strengthen social bonds and support networks that
   may have been fragmented by disaster.

An example of community organization common after many disasters is the organization of
self-help networks for disaster preparedness. Citizens gather in a series of neighborhood 
meetings, They inventory and mitigate local hazards, such as clearing brush that is a fire
hazard. They find resources in the neighborhood (skills such as nursing or firefighting
equipment such as CB radios or camping gear). They also survey household needs in a disaster,
such as children home alone after school who would need care. Neighbors decide task 
assignments for neighbors usually home during the day, such as turning off utilities in the
neighborhood, providing first aid, and helping children who are home alone. They meet
periodically to review and modify the plan (annually and as new neighbors move in). The
groups hold periodic drills or practice sessions, often making them "fun" in the process
(e.g., a potluck supper prepared and eaten without electricity or gas).

Such groups have organized around emergency preparedness following floods, mudslides,
earthquakes, and wildfires. Group members report a marked increase in people's sense of
safety and well-being, confidence in their ability to act effectively in an emergency,
and sense of support and teamwork among neighbors. Such community organizations also
strengthen the bonds of social support among survivors. Many individuals report 
satisfaction in getting to know and work with their neighbors, and groups often expand
their scope to work together on a variety of other neighborhood concerns (Garaventa, 
Martin and Scremin, 1984).

Community organization techniques may also be used to mobilize informal resources within
the community. For example, after floods and mudslides devastated Inverness, CA in 1982,
no formal agency in the community existed to help survivors with the grueling work of 
digging mud out of their basements and crawl spaces. This was a particular problem for 
frail elderly who were unable to perform the labor themselves. When this problem surfaced
at a community meeting, young adults and teens organized a group they named the "Mole
Patrol", which made its sole mission the digging out of mud. When the job was done many
months later, the informal group disbanded. 

SUMMARY

Because the entire community is affected by a disaster, and because survivors generally
do not seek out mental health resources, outreach will be a key component of a
successful mental health disaster recovery program. Outreach will be to individual
survivors and to the community as a whole. It may take the form of casefinding and
outreach to individuals, public education, mental health training, consultation,
community organization, and advocacy. Mental health workers will do well to incorporate
the characteristics of successful outreach programs learned from prior recovery projects
in order to successfully reach the affected population of survivors.
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REFERENCES

Cohen, R.E. and Ahearn, F.L. (1980). Handbook for mental health care of disaster victims. 
Baltimore: The Johns Hopkins University Press.

DeWolfe, D. (1992). "A Guide to Door-To-Door Outreach". Final Report: Regular Services Grant, 
Western Washington Floods. State of Washington Mental Health Division.

Garaventa, D., Martin, P. and Scremin, D. (1984). "Surviving the Flood: Implications for Small 
Town Disaster Planning." Small Town, 14(4): 11-18.

Myers, D. (1989). Mental health and disaster: Preventive approaches to intervention. In Gist, R.
and Lubin, R. (Eds.), Psychosocial aspects of disaster. New York: John Wiley and Sons.

Peuler, J. (1985). Family and community outreach in times of disaster: The santa Cruz experience.
In Lystad, M. (Ed.), Innovations in Mental Health Services to Disaster Victims. Rockville, 
MD: National Institute of Mental Health.

Ross, M. (1967). Community Organization: Theory, Principles, and Practice. New York: Harper and
Row. 

Taillie, D. (1969). The Role of the Psychiatric Nurse in Community Organization. Unpublished
Masters Thesis, Yale University. New Haven, CT. 

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