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Moving Forward

Moving Forward. Rick Peterson, Ph.D. LMFT, CFLE. Putting the Pieces Back Together. Moving Forward. Questions How many phases or stages in a disaster? What are common stress reactions? Who are vulnerable populations during a disaster?

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Moving Forward

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  1. Moving Forward Rick Peterson, Ph.D. LMFT, CFLE Putting the Pieces Back Together

  2. Moving Forward • Questions • How many phases or stages in a disaster? • What are common stress reactions? • Who are vulnerable populations during a disaster? • What is the average percentage of the U.S. population with disabilities? • Who is mandated to provide disaster mental health services during and after a disaster?

  3. Stages of Disaster • Heroic • Honeymoon • Disillusionment • Reconstruction

  4. Heroic Phase

  5. Honeymoon Phase

  6. Disillusionments Phase

  7. Reconstruction Phase

  8. Disaster and Recovery Stress • Stress reactions are normal reactions to an extraordinary and abnormal situation and are to be expected under the circumstances. • Stress Impacted by: • Personal loss • Money problems • Changes at home and work • Problems of living caused by the disaster

  9. Difficulty sleeping Inability to relax Increased moodiness More arguments Change in eating habits Stomach/ digestion problems Feeling of sadness Withdrawal Feelings of helplessness Fatigue Lack of interest Increased intake alcohol/drugs Headaches Stress Symptoms

  10. Vulnerable Populations Disabled Children Elderly

  11. Vulnerable Populations • Vulnerable populations “are people who feel they cannot comfortably or safely access and use the standard resources offered in disaster preparedness, relief and recovery.” • Include but are not limited to: • physically or mentally disabled • limited or non-English speaking • geographically or culturally isolated • medically or chemically dependent • homeless, frail/elderly and children.

  12. Vulnerable Populations • Children

  13. Children, Birth to Age Two • Have little understanding of cause and effect relationships • They do not have past experiences to deal with a crisis • When these young children experience trauma, they cannot verbally communicate their stress. • However, they can retain memories of sights, sounds, and smells related to the event, and their later play may involve acting out the trauma.

  14. Interventions for Young Children • Give verbal assurance and physical comfort. • Provide comforting bedtime routines. • Avoid unnecessary separations. • Permit the child to sleep in the parents’ bedroom temporarily. • Encourage children to express their feelings and grief regarding their losses (i.e., deaths, pets, toys). • Monitor media exposure to disaster trauma. • Encourage expression through play activities.

  15. Children, Ages 6–11 • May become preoccupied with the event and show signs of regressive behavior or have night terrors. • They understand the permanence of their loss and may express guilt or anger. • They may avoid going to school, which is a common reaction to the event.

  16. Adolescence 12-17 Years Old • May withdraw or become isolated • Increased Antisocial behaviors ( aggressive or acting out) • School problems • Increase in risk-taking behaviors (alcohol and drugs) • Depression and sadness

  17. Interventions School Age Children • Give additional attention and consideration. • Relax performance expectations temporarily at home/school. • Set gentle but firm limits for acting-out behavior. • Provide structure. • Encourage them to express their thoughts and feelings verbally and through their play. • Listen to the child’s repeated retelling of the disaster event. • Rehearse safety measures for future disasters.

  18. Vulnerable Populations • Those with Disabilities • Accommodating people with disabilities often translates into being better equipped to serve all.

  19. Percent of Population with Disabilities

  20. Disabilities • Physical • Blind • Deaf and/or hard-of-hearing • Cognitive disorders • Mobility limitations • Mentally disabled • Medically or chemically dependent

  21. Vulnerable Populations • Elderly • Late-life feelings of personal loss intensified by disaster • Physical or emotional frail • Special concerns • Sensory deprivation- older person’s sense of smell, touch and hearing are likely to be less acute. • Delayed Response – older person’s may respond slowly to calls for disaster relief due to age-related slowing of cognitive and motor activities.

  22. Elderly • Special concerns • Chronic illness and dietary considerations • Multiple loss effect • Hyper and hypothermia vulnerability • Transfer trauma

  23. Working with Older Persons • Provide strong and persistent verbal reassurance • Assist with recovery of physical possessions, make frequent home visits • Help re-establish family and social contacts • Assist in obtaining medical and financial assistance • Help re-establish medication regimens

  24. Long-Term Problems • In some cases, disaster survivors may have long-term problems • Depression, • Prolonged grief • Post-Traumatic Stress Disorder (PTSD). • Anniversary Reactions

  25. Depression & Symptoms • Persistent sad or irritable mood, • Loss of interest in activities once enjoyed, • Significant change in appetite or body weight, • Difficulty sleeping or oversleeping, • Loss of energy, feelings of worthlessness/inappropriate guilt, • Difficulty concentrating, • Recurrent thoughts of death or suicide. • Five or more of these symptoms that persist for two or more weeks may indicate a major depression. • If you suspect someone is experiencing depression, they should be evaluated by a qualified mental health professional.

  26. Post-Traumatic Stress Disorder • PTSD is re-experiencing the event through play, nightmares, flashbacks and frightening thoughts, routinely avoiding reminders of the event and diminished interest or emotional numbness, increased sleep disturbances, irritability, poor concentration, and depression or regressive behavior. • Symptoms must be present for longer than one month.

  27. Disaster Anniversary Reactions • Not all survivors experience anniversary reactions • Normal part of loss and grief • Reactions may include: • Fear, anxiety, and stress • Grief, sadness and regret • Dreams, old thoughts and feelings • Frustration and anger

  28. Degree of Personal Impact • Researchers have consistently shown that the more personal exposure a survivor has to the disaster’s impact, the greater the survivor’s post-disaster reactions. • The death of a family member, loss of a home, and destruction of a community represent high-stress impact events. • In each event, the intertwining of grief and trauma compounds the effects and extends the duration of the recovery period for many survivors.

  29. Loss and Grief

  30. Come to Terms With Your Grief • Accept The Loss - It is natural to protect yourself. • Feel The Pain - Recognize and experience your emotions. • Talk About It - Talking about the loss and reminiscing helps you to accept the situation. • Take One Day At a Time - Do not try to sort out everything at once. • Take Care Of Yourself - Get plenty of rest, eat well, take time to retreat, and time to talk. Try not to become isolated but seek out social support. • Adapt To Change -This may mean taking on a new role, learning new skills, or learning how to live on your own. • Let Go - When you are ready, let go. This does not mean forget.

  31. Be aware of agencies and resources available in the community. Listen for and observe signs of stress and/or depression symptoms. For children discuss what you have observed with the child’s parents/caregivers. Check to see if the parents/caregivers have seen similar things at home. If warranted, discuss with the parents/ caregivers the need to refer the child to an appropriate agency/resource for assistance. Explore the parents’/caregivers’ willingness to contact the referral. Set up a time that you can contact the parents/ caregivers to check on the action that they took. Simply ask the parents/caregivers when you might follow-up with them to see how the referral went. Referrals

  32. Problem-Solving • Problem identification and agreement • Creating options and alternatives • Evaluate alternatives • Choose a solution • Implement the solution/plan • Evaluate the success of the plan

  33. Problem Ownership ?

  34. Disaster Mental Health • Department of State Health Services is mandated to provide disaster mental health services during a state or federally declared emergency. • The primary goal of the program is to mitigate the long-term mental health impact of acute and/or ongoing stress experienced by responders, survivors and victims of natural and manmade disasters.

  35. Moving Forward • Questions • How many phases or stages in a disaster? • What are common stress reactions? • Who are vulnerable populations during a disaster? • What is the average percentage of the U.S. population with disabilities? • Who is mandated to provide disaster mental health services during and after a disaster?

  36. Contact Information • Rick Peterson • (979) 845-1877 • rlpeterson@ag.tamu.edu

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