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In Times of Crisis : Supporting Others, Supporting Ourselves

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  1. In Times of Crisis:Supporting Others,Supporting Ourselves John Gaspari, LCSW Executive Director USC Center for Work and Family Life

  2. Introductions Importance of beginnings and endings

  3. Center for Work and Family Life Available Services: • Faculty and Staff Counseling • Faculty, Management and Departmental Consultation • Critical incident response • Work/Life Support • Family and Dependent Care: Consultation and Resources • Workplace Health and Wellness Programs

  4. Role Expectations • Are you clear about your the role expectations you carry as a member of the CERT? • Can you imagine having any unfulfilled expectations or disappointments while functioning in this role? • How might the many other roles you play at any given time impact your role as a CERT member?

  5. Unit Objectives • Psychological impacts to expect after a disaster – What happens for people? • How to work with the psychological impacts in your role – Providing psychological support. • Responder stress management and self-care.

  6. Are We Psychologically Prepared? • For every physical injury, there may be 5-6 psychological injuries • This may overwhelm and impede our emergency and/or medical response.

  7. Critical Incident • Exposure to a traumatic event in which both of the following were present: • The person experiences, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. • The person’s response involved intense fear, helplessness or horror. (DSM-IV TR)

  8. CRISIS danger; peril opportunity; crucial point

  9. Coping Mechanisms • People typically rely on past strategies to cope with new stressful situations • Past coping mechanisms can be functional or dysfunctional. • Degree of hardiness (resilience) has been identified as a characteristic that can buffer extreme stress in older populations • Children can be vulnerable because they have no experience or known patterns of actions as a response to the experience.

  10. Into every life a little rain must fall ….. But what happens when there is a flood?

  11. Psychosocial Impact – Considerations • Prior experience with a similar event • Prior trauma • The intensity of the disruption in the survivors’ lives • The resilience of the individual

  12. Psychosocial Impact – Considerations • The length of time that has elapsed between the event occurrence and the present • Pre-existing vulnerabilities • Man-Caused vs. Naturally Occurring Events • Children/families • Seniors • Disabled • Bereaved • Health impairments • Women

  13. Psychological Response to TraumaKey Principles • Man-Caused vs. Natural Events • Adult Coping & Adaptation

  14. Consequences of Critical Incidents Often include LOSS • Tangible Loss • Loss of loved ones • Loss of home • Loss of material goods • Loss of employment / income

  15. Consequences of Critical Incidents Often include LOSS • Intangible Loss • Loss of safety / security (real or perceived) • Loss of predictability • Loss of social cohesion/connection/support • Loss of dignity, trust and safety • Loss of positive self-image/self-esteem • Loss of trust in the future • Loss of hope • Loss of CONTROL

  16. Activity – What if I lost… • You have been given three cards each of three different colors: • Blue Card - write the name of a person close to you on each card • White Card - write down one of your favorite belongings • Pink Card - write down something you enjoy, an activity, or hobby. • After you have written on each card, place them face down on the table and shuffle them around. Close your eyes and pick three cards.

  17. Activity – What if I lost… • These are the three things you will have lost in a disaster. • Discuss with the group how you feel about losing these things or people

  18. Possible Psychological Reactions to a Large-Scale Emergency • Many people survive disasters without developing any significant psychological symptoms. • For other individuals, the reactions will disappear over time. “Just because you have experienced a disaster does not mean you will be damaged by it, but you will be changed by it.” (Weaver 1995)

  19. Grief and Loss • Not an even process • Takes time • Can become stuck in the process • May spawn other problems • Nothing like T & T (Time and Talking)

  20. Supporting Others

  21. “We’re a community that believes in ‘love thy neighbor’, but right now we need to love our neighbors a little bit more.” • Man talking after devastating tornados ripped through his Tennessee neighborhood - 2/08

  22. Role of Disaster Mental Health? • Primarily directed toward “normal” people who are responding normally to an abnormal situation • Improve resistance, resilience and recovery. • Identifying those at risk for severe social or psychological impairment • Identify those in need of additional or special services.

  23. Role of Disaster Mental Health? • Mitigate post trauma sequelae • May prevent future problems • Helps people to handle problems in a way that does not create MORE problems • Convey sense of compassion and support for people.

  24. Psychological Response to TraumaKey Concepts • Experience has shown that: • No one who sees a disaster is untouched by it. • Most people pull together & function during and after a disaster, but their effectiveness is diminished. • Most people do not see themselves as needing mental health services following a disaster and will not seek such services.

  25. Psychological Response to TraumaKey Concepts • Experience has shown that: • Survivors respond to active, genuine interest & concern. • Survivors may reject disaster assistance of all types. • Disaster mental health assistance is often more practical than psychological in nature. • Social support systems are crucial to recovery.

  26. Psychological Response to TraumaKey Concepts • While there may be specific disaster-related stressors, underlying concerns and needs are consistent across a range of traumatic events. These include: • A concern for basic survival • Grief and loss over loved ones & loss of valued and meaningful possessions • Fear & anxiety about personal safety & the physical safety of loved ones • A need to talk about events & feelings associated with the disaster, often repeatedly • A need to feel one is a part of the community & its recovery efforts

  27. Phases of Disaster Honeymoon (community cohesion) llllllllllll Reconstruction (a new beginning) Heroic Pre-Disaster Disillusionment Working Through Grief (coming to terms) Threat EVENT Warning Inventory Trigger Events and Anniversary Reactions Time 1 to 3 days 1 to 3 years

  28. Phases of Disaster • Heroic Phase • Honeymoon Phase • Disillusionment Phase • May last from two months to several years. • Strong feelings of anger and resentment can be directed at volunteers and other public officials. • Reconstruction Phase

  29. Honeymoon (community cohesion) • Survivors may be elated • Happy just to be alive • This phase will not last

  30. Disillusionment • Reality of disaster “hits home” • Loss and Grief becomes prominent

  31. Psychological Support • Your actions and interactions with affected people can • help provide critical support to people in distress. • relieve suffering, both emotional and physical • Improve people’s short term functioning • Accelerate the individual’s course of recovery

  32. Brainstorming • What main attributes and skills should a volunteer have when offering psychological support? • Spend 5 minutes brainstorming and writing down those characteristics which are likely to be required.

  33. Essential Attributes and Skills • Good Listening skills • Patient • Caring attitude • Trustworthy • Approachable • Culturally competent • Empathetic

  34. Essential Attributes and Skills • Non-judgmental approach • Kind • Committed • Flexible • Able to tolerate chaos

  35. Supportive Communication • Supportive communication conveys: • Empathy • Concern • Respect • Confidence

  36. Activity – Supportive Statements • As a group, generate a list of supportive statements that you would find helpful if you were in pain, injured, and/or acute emotional distress.

  37. Activity – Unhelpful Statements • As a group, generate a list of statements that you would find unhelpful if you were in pain, injured, and/or acute emotional distress.

  38. Guiding Principles in Providing Psychological Support in Your Role • Protect from danger • Be direct and active • Provide accurate information about what you’re going to do • Reassure • Do not give false assurances • Recognize the importance of taking action • Provide and ensure emotional support

  39. Crisis Intervention • Observe safe practices by showing concern for your own safety • Remain calm and appear relaxed, confident and non-threatening • You must look and act calm even if you are not

  40. Goals of Psychological First Aid • Psychological first aid (PFA) promotes and sustains an environment of: SAFETY CALM CONNECTEDNESS SELF-EFFICACY HOPE

  41. Psychological First Aid • Promote SAFETY: • Help people meet basic needs for food and shelter, & obtain medical attention. • Provide repeated, simple and accurate information on how to get these basic needs met.

  42. Psychological First Aid • Promote CALM: • Listen to people who wish to share their stories and emotions, & remember that there is no right or wrong way to feel. • Be friendly & compassionate even if people are being difficult. • Offer accurate information about the disaster or trauma, and the relief efforts underway to help victims understand the situation.

  43. Psychological First Aid • Promote CONNECTEDNESS: • Help people contact friends and loved ones. • Keep families together. Keep children with parents or other close relatives whenever possible.

  44. Psychological First Aid • Promote SELF-EFFICACY: • Give practical suggestions that steer people toward helping themselves. • Engage people in meeting their own needs.

  45. Psychological First Aid • Promote HELP: • Find out the types and locations of government & non-government services and direct people to those services that are available. • When they express fear or worry, remind people (if you know) that more help and services are on the way.

  46. Do Say… • Can you tell me what happened? • I’m Sorry • This must be difficult for you • I’m here to be with you

  47. Psychological First Aid • DON’T: • Force people to share their stories with you, especially very personal details (this may decrease calmness in people who are not ready to share their experiences). • Give simple reassurances like “everything will be ok”, or “at least you survived” (statements like these tend to diminish calmness).

  48. Psychological First Aid • DON’T: • Tell people what you think they should be feeling, thinking or doing now or how they should have acted earlier (this decreases self-efficacy). • Tell people why you think they have suffered by giving reasons about their personal behaviors or beliefs (this also decreases self-efficacy).

  49. Psychological First Aid • DON’T: • Make promises that may not be kept (un-kept promises decrease hope). • Criticize existing services or relief activities in front of people in need of these services (this may decrease hopefulness or decrease calming). • Source: Center for the Study of Traumatic Stress

  50. Avoid Saying . . . • “I understand what it’s like for you.” • “Don’t feel bad.” • “You’re strong/You’ll get through this.” • “Don’t cry.” • “It’s God’s will.” • “It could be worse” or “At least you still have . . .”