Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT August 2, 2002 "To be a great champion you must believe you are the best. If you're not, pretend you are." - Muhammad Ali
Short Subjects
LINKS Mental Health Moment Online CONFERENCES AND WORKSHOPS:
Fifth Annual Innovations in Disaster Psychology Conference
"Psychosocial Reactions to Terrorist Attacks"
Sept. 29-Oct 1
Location: Radisson Hotel
Rapid City, South Dakota
2nd World Conference
on the Promotion of
Mental Health and Prevention
of Mental and Behavioral
Disorders: "Developing
Partnerships - Science,
Policy, and Programs
Across Cultures"
September 11-13, 2002
London, UNITED KINGDOM
Contact: The Conference Office
Clifford Beers Foundation
Mariazell, 5 Castle Way
Stafford ST16 1BS, United Kingdom
Tel: 44 (0) 1785 246668
Fax: 44 (0) 1785 246668
E-mail: michael_murray@
charity.demon.co.uk4th World Congress on Stress
September 12-15, 2002
Edinburgh, Scotland
UNITED KINGDOM
Contact: Northern Networking Ltd
1 Tennant Avenue
College Milton South
East Kilbride, Glasgow G74 5NA
Scotland, UK
Tel: 44 (0) 1355 244966
Fax: 44 (0) 1355 249959
E-mail:
stress@
glasconf.demon.co.uk89th International Conference:
Stress and Depression
October 20, 2002
Milan, ITALY
Contact:
Istituto di Psicologia
Clinica Rocca-Stendoro
Corso Concordia 14
Milan 20129, Italy
Tel/Fax: 39-02-782627
E-mail: ist.roccastendoro@libero.it
INSTITUTE WORKS TO RESOLVE CONFLICTS VIA TECHNOLOGY
In Kosovo, U.S. peacekeeping forces faced stone-throwing mobs. In Somalia, as portrayed in the recent hit movie "Black Hawk Down," U.S. soldiers were forced to defend themselves on a city street filled with civilians. And closer to home, hostages are held at gunpoint behind barricaded doors while police weigh unreasonable demands and struggle to save innocent lives. Since the early 1990s, police and the military have explored non-lethal technologies to limit the use of deadly force yet successfully deal with major conflicts involving thousands of people. Starting in 1997, a Penn State research group, known as the Institute of Emerging Defense Technologies, has been studying a wide array of existing and emerging technologies in hopes of helping law enforcement and the military develop alternatives to conventional lethal and non-lethal weapons systems. In addition to providing scientific analysis and research, the institute reviews legal, social and ethical implications of using non-lethal technologies as well. Projects funded through the institute range from noise reduction in military armored vehicles to better sensors for detecting highly toxic chemicals used in a public attack or biological agents such as anthrax. For more information about the innovative work by the institute to preserve and protect lives, visit http://www.arl.psu.edu/areas/defensetech/defensetech.html. For the full story, visit http://www.psu.edu/ur/2002/iedt.html
EXPERT TO HEAD INVESTIGATION OF MINE ACCIDENT
Raja V. Ramani, professor emeritus of mining and geoenvironmental engineering at Penn State, is heading a special commission to investigate the causes of the Somerset County Quecreek Mine Accident, appointed by Gov. Mark Schweiker. Ramani is a registered professional engineer and certified mine manager, health and safety instructor, and health safety professional, with more than 40 years of experience. A member of the Penn State faculty from 1970 to 2001, Ramani held the George H. and Anne B. Deike Jr. Chair in Mining Engineering in the College of Earth and Mineral Sciences and was head of the Department of Mineral Engineering and director of the interdisciplinary Mineral Engineering Management Program. He also directed the Miner Training Program and co-directed the Standard Oil Center for Excellence in Longwall Mining, the Generic Mineral Technology Center for Respirable Dust, and the National Mined Land Reclamation Research Center. For the full commission release, visit http://www.state.pa.us/papower/cwp/view.asp?Q=430993&A=11
Red Cross Volunteers Share In Joy and Relief of 'Mining Miracle'
Supporting the needs of families during and after emergencies is nothing new to the American Red Cross. Neither is the devastation caused by disasters. Last weekend, however, a few Pennsylvania Red Cross volunteers were able to share in the joy of family members, an opportunity and privilege they say they will never forget.
FEMA Director Presents Firefighting Equipment Grant
In a special ceremony Tuesday, July 30, Joe M. Allbaugh, director of the Federal Emergency Management Agency (FEMA), presented the Pitkin, CO Volunteer Fire Department with a $117,000 grant for improved firefighting equipment.
Wendolyn Heiges of American Red Cross International Services, recently visited Afghanistan to assess how AFAC can continue to meet the most pressing needs of children. While there, she went on a tour of Afghan schools, talking to students, teachers and administrators about the conditions, and documenting her findings with notes and photographs.
GLOBE-TROTTER KEEPS AIR FORCE HEALTHY
As an undergraduate scurrying to make classes on time, Daniel S. McNulty never imagined the fast-paced existence awaiting him as a globe-trotting officer in the United States Air Force (USAF). McNulty works in the headquarters of the USAF Surgeon General's Office and the Department of Defense: the Pentagon, where he directs personnel in support of Air Force Global Health initiatives and serves on the HQ Air Force Crisis Action Team. The team works in a bunker in the Pentagon to monitor the war and all Air Force deployments. For the full story visit: http://www.aa.psu.edu/ur/ivyleaf/ss02/alumni.htm
DISASTER MENTAL HEALTH TRAINING
The knowledge and skills required of mental health workers in disaster differ from those needed in non-disaster situations and times. Because of this, special attention needs to be given to the selection and training of disaster mental health teams.
TRAINING DURING DISASTERS
Immediately following impact, mental health administrators may feel pressured to deploy their staff without delay. However, the urgency of disasters underscores the value of having a core team of staff who are trained in disaster response prior to the occurrence of a disaster. When such a team is not in place, training must be conducted during the disaster response and recovery activities. This may require some juggling of schedules and personnel, but it has been done and remains essential to the success of the mental health response. Administrators and staff will have to shift from the pace of a regular work week to "disaster time" which often involves working 12-hour days and week-ends.
Because of the urgency of immediate response, the timeframe required for a comprehensive disaster mental health training (2-5 days) is probably unrealistic. Skilled trainers may not be instantly available. Comprehensive training may need to be postponed for a few days or weeks.
If possible, select disaster response staff who have good crisis intervention and community relations skills. These are the skills that are most transferable to the disaster situation. Ideally, a trainer should have disaster experience. However, if one is not available, an experienced crisis intervention worker can use the available training materials to provide staff with basic training. The National Institute of Mental Health Training Manual for Human Service Workers in Major Disasters (Farberow and Fredereick, 1978) provides essential information on phases of disaster, common stress reactions of adults and children, and suggested interventions. In an urgent temporal situation, staff can read the materials and take them with them into the field. The National Institute of Mental Health Field Guide for Human Service Workers in Major Disasters is a reference guide for use by workers in the field.
Video training tapes can also be used until an experienced trainer can be engaged for comprehensive training.
The time allotted for this "basic" training will vary according to local circumstances. However, if possible, at least a half-day should be devoted to training and orientation. Additionally, at least one and a half to two hours should be set aside for debriefing of staff before the training.
Training may need to be repeated one or more times, so that staff can attend in "shifts" while other workers provide services. The training should also be repeated as new personnel such as volunteers, mutual aid, or extra-hire personnel come on board. On the job training can be provided by linking inexperienced disaster mental health workers with those who have prior disaster experience. Experienced workers should be part of a core team that was trained pre-disaster. They may be the mutual aid staff who have come from another jurisdiction to assist. An experienced worker assigned to a team of new workers can provide on-scene consultation, direction, and role modeling.
ORIENTATION
Managers need to be sure that an orientation to the disaster is provided to mental health staff prior to deployment. Following are some of the topics that should be covered:
1. Status of the disaster: nature of damages and losses, statistics, predicted weather or condition reports, boundaries of impacted area, hazards, response agencies involved.2. Orientation to the impacted community: demographics, ethnicity, socioeconomic makeup, pertinent politics, etc.
3. 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 Services (OES) 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 staff. Provide workers with a supply of mental health brochures or fliers to give to survivors, outlining normal reactions of adults and children, ways to cope, and where to call for help. For volunteers or mutual aid personnel, provide a brief description of the sponsoring mental health agency.
4. Logistics: arrangements for workers' food, housing, obtaining messages, medical care, etc.
5. Communications: how, when, and what to report through the mental health chain of command; orientation to use of cellular phones, two-way radios, or amateur radio volunteers, if being used.
6. Transportation: clarify mode of transportation to field assignment. If workers are using personal vehicles, provide maps, delineate open and closed routes, and indicate hazard areas.
7. Health and safety in a disaster area: outline potential hazards and safety strategies (e.g., protective action in earthquake aftershocks, flooded areas). 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 first aid/medical resources in the field.
8. 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.
9. 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.
10. 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.
TRAINING OBJECTIVES
Comprehensive training on disaster mental health needs to be provided for all staff and volunteers who will be involved in disaster response and recovery. This should include management and administrative personnel who will be closely involved. Training should be mandatory.
Effective disaster mental health training should provide participants with certain knowledge, skills, and attitudes which will enhance their effectiveness in the disaster setting. Disaster mental health work requires a perceptual shift from traditional mental health service delivery. Because of that, the acquisition of new skills and information is essential.
Objectives of a comprehensive disaster mental health training should provide participants with the knowledge, skills, and attitudes which will enable them to:
1. Understand human behavior in disaster, including factors affecting individuals' response to disaster, phases of disaster, "at risk" groups, concepts of loss and grief, postdisaster stress, and the disaster recovery process.2. Intervene effectively with special populations in disaster, 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.
3. Understand the organizational aspects of disaster response and recovery, including key roles, responsibilities, and resources; local, state, federal, and voluntary agency programs; and how to link disaster survivors with appropriate resources and services.
4. Understand the key concepts and principles of disaster mental health, 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.
5. Provide appropriate mental health assistance to survivors and workers in community settings, with emphasis on crisis intervention, brief treatment, post-traumatic stress strategies, age-appropriate child interventions, debriefing, group counseling, support groups, and stress management techniques.
6. Provide mental health services at the community level, with emphasis on case-finding, outreach, mental health education, public education, consultation, community organization, and use of the media.
7. Understand the stress inherent in disaster work and recognize and manage stress for themselves and with other workers.
SELECTING TRAINERS
Those chosen to provide disaster mental health training need to have knowledge, skills, and experience that will enable them to meet the above training objectives. This should ideally be persons who have worked in at least one actual disaster (preferably more). Additionally, they need to have a good understanding of principles of adult learning, and must have excellent training skills to promote learning of knowledge, skills and attitudes.
Teaching disaster mental health involves working in the domain of emotions. Students often find that the material about disasters triggers deep feelings in themselves. The trainer must be comfortable and skilled in group process and appropriate classroom discussion of emotions.
When a large group of people are being trained (over about 60), it is advisable to have more than one trainer in order to facilitate group discussion and skills practice. It is also possible to use trainers with different areas of expertise to teach various aspects of the material.
Training about ethnic groups affected by the disaster should ideally be done by individuals who are indigenous to the specific groups and familiar with conducting ethnic diversity training for majority culture groups.
Representatives of state, federal, and voluntary agencies should provide training about their resources and programs. The intent is to familiarize mental health staff with programs to help them make effective referrals. At no time should mental health staff attempt to make determinations about individuals' eligibility for state or federal programs. Involving state and federal representatives in the training will also enhance the linkage and communication between mental health and the various programs. This part of the training can be arranged by contacting the Individual Assistance Officer (IAO) for the state Office of Emergency Services, and the Voluntary Agencies (VOLAG) coordinator at the Disaster Field Office.
If a trainer comes from outside the impacted area and is not familiar with the community, the mental health agency should help the trainer by providing him/her with background on the community and on the disaster. Census tract information, newspaper clippings, or videotapes of the disaster will help the trainer to tailor the training to local characteristics and needs. The trainer should read the FEMA Crisis Counseling grant application if one has been written.
TOPICS FOR TRAINING
Following are some recommended topics for inclusion in a comprehensive disaster mental health training program:
1. Understanding Disaster and Disaster-related Behavior
a. Definition of disaster2. Special Populations in Disaster: issues and Interventionsb. Myths and realities of human behavior in disaster
c. Factors affecting the psychological response of individuals to disaster
(factors related to the disaster, the individual, and the social
situation).d. "At risk" groups following disaster
e. Phases of disaster
f. Psychological, cognitive, behavioral, and affective responses to disaster
g. Differential assessment of normal responses vs those requiring intervention
a. Children3. Roles, Responsibilities, and Resources in Disasterb. Older adults
c. People with disabilities
d. the mentally ill
e. Ethnicity and disaster
f. People with previous traumatic experiences
a. The disaster declaration process4. The Disaster Recovery Processb. Chain of command among local, state, and federal authorities
c. Local, state, and federal mental health programs
d. Purpose and objectives of the FEMA crisis counseling programs
(if appropriate)e. Government and voluntary agency resources and services for
disaster survivorsa. Loss and Grief5. Key Concepts of Disaster Mental Healthb. Post-traumatic stress
c. Interplay of individual recovery and community recovery processes
a. Survivors' perception of needs6. Effective Interventions with Disaster Survivorsb. Scope of community needs
c. Milieu and time factors
d. How effective disaster mental health interventions differ
from traditional psychotherapye. Spectrum and design of mental health services in disaster
f. Sites for disaster mental health service delivery
a. Disaster preparedness7. Effective Interventions at the Community Levelb. Crisis intervention
c. Brief treatment
d. Post-traumatic stress strategies
e. Age-appropriate child interventions and school programs
f. Debriefing
g. Group counseling and support groups
h. Stress management techniques
a Casefinding8. Disaster Work and Mental Health: Prevention and Control of Stress Among Workersb. Outreach
c. Mental health training
d. Public education, including effective use of media
e. Consultation
f. Community organization
a. Sources of stress for workers (including mental health workers)b. Stress management for workers before, during, and after the disaster
Special Consideration
Paraprofessional staff who do not have prior human service experience will need training in communications and peer counseling skills before attending the comprehensive disaster mental health training. Topics should include the following:
* Basics of crisis interventionClose clinical supervision should be part of the organizational structure. Training must provide peer counselors with information regarding how and when to consult with their supervisors and how and when to refer individuals. They should be provided with specific indicators of when they are becoming over involved with a client, and how to overcome this professional vulnerability.* Establishing rapport
* Active listening and responding skills
* Attending to feelings
* Interviewing techniques
* Paraphrasing and interpretation
* Cognitive reframing techniques
* Non-verbal communication
* Group dynamics
* Helpful and unhelpful styles of assistance
* When and how to refer to mental health
* How to link clients with resources
* Ethics (confidentiality, boundaries of relationship with the client, etc.)
* Legalities (duty to report to child protective services, etc.)
* Risk factors for suicide
* Handling difficult situations
FORMAT FOR TRAINING
Ideally, a comprehensive disaster mental health training will take from two to five days. The length of the training will vary according to the disaster, the location, prior experience of the staff, and the trainer.
A variety of instructional methods should be used to transmit the knowledge, skills and attitudes encompassed in the comprehensive objectives. Interactive teaching methods are important. Skills practice which approximates the true disaster scene is crucial. Exposure to scenarios and case studies that will challenge participants to examine their own emotional responses to disaster is also essential. A mix of methods such as didactic presentations, reading, videotapes, self-awareness exercises, discussion sessions, demonstrations, skills practice, and supervised field experience will help to achieve the training objectives.
TRAINING DURING THE LONG-TERM RECOVERY PROCESS
Ther will continue to be a need for disaster mental health workers even as disaster response efforts are completed and the longer-term recovery efforts commence.
When a FEMA Regular Program grant is sought and is awarded for crisis counseling services, new or additional staff may be hired for the program. If they have not had a comprehensive disaster mental health training program, such a program should be provided or repeated when staff are hired.
In addition to the comprehensive training program, inservice and/or consultation should be provided at regular intervals. Staff and supervisors working on long-term recovery efforts must be attuned to training needs that may arise during the work. Some needs are unique to a given disaster or locale. Such training, when tailored to specific needs as thay arise, can assist staff in overcoming service-delivery barriers they may encounter along the way. Training always provides a welcome infusion of ideas and gives a boost to staff morale. The Crisis Counseling grant application should include funding for appropriate levels of inservice training and consultation.
Staff may need in-depth training on a subject covered briefly in the comprehensive training. They may find that topics not covered in the training are needed. Some common training needs and interests seem to occur regularly in long-term recovery programs. The following include some examples:
* treatment of post-traumatic stress disorderIt is recommended that the staff complete written evaluations of training sessions as they occur. Evaluations provide useful feedback to the trainer. They also provide information to managers about the perceived usefulness of the training. Following the end of the disaster recovery program, a critique of the training component of the program is also useful. The FEMA Crisis Counseling program final report should include the results of the critique as a way of helping other projects with their training components. It should also be kept with the local disaster mental health plan as documentation of what was done for use in future disasters.* treatment of post-traumatic stress disorder and alcohol abuse/dependence
* interventions with complicated bereavement
* advanced group dynamics
* expressive therapies (art, music, writing) for use with adults and children
* advanced peer counseling for paraprofessionals
* disaster and family issues
* stress management interventions for survivors and workers
* long-term recovery issues and interventions
* outreach techniques for long-term recovery
* the first anniversary: individual reactions and community recovery efforts
* community organizing at the neighborhood level
* specialized topics important to understanding and helping survivors, e.g.,
insurance issues, the city or county permit process, working with architects
and contractors* specialized topics pertinent to the local disaster (e.g., floodplain
management, seismic safety, hurricane warning systems)* preparing for termination of the project: termination of relationships
with clients, referral of clients to appropriate resources, notification
of community regarding ending of services***********************************************************************************************
REFERENCES Farberow, N.L. and Frederick, C.J. (1978). Training manual for human service workers in major disasters. Rockville, MD: National Institute of Mental Health.
***********************************************************************************************
To search for books on disasters and disaster mental
health topics, leaders, leadership, orgainizations,
crisis intervention, leaders and crises, and related
topics and purchase them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
********************************************************************************************************************************************
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.
**********************************************************************
George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
||| Volume 1 ||| Volume 2 ||| Volume 3 ||| Volume 4 ||| Volume 5 ||| Volume 6 ||| Additional Links |||
Mental Health Moment Online
