Transcript FEMA Crisis Counseling Program

Keeping the Faith:
Disaster Care
Sheldon Rosenzweig
Compassion Coalition of Tuscaloosa County, Inc.
Presented December 4, 2008
This presentation is adapted from FEMA CCP Training, NIOSH, CDC,
Washington State Department of Mental Health, Project Rebound (Alabama
State Department of Mental Health) and other sources.
Overview
Characteristics of Disasters and
Reactions
 Stress and Grief – Be Your Own
Advocate
 Coping and Recovery – Tests of Faith
 Professional Care – Giving and
Receiving
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Every Disaster is Different
Disasters cause disruption and changes that can
include:
• Loss of life and/or property;
• Injury and/or illness;
• Disruption of community support systems and/or
infrastructure;
• Disruption to family and/or relocation;
• Unemployment;
• Changes in school configurations;
• Interaction with large bureaucracies;
• Influx of outsiders into the community; and
• Increase in substance use or abuse.
Community Reactions:
Phases of Disaster
Adapted from CMHS, 2000.
Disaster Reactions
People pull together during and after a
disaster;
 Stress and grief are common reactions
to an uncommon situation;
 Most people’s natural resilience and
support systems will support their
recovery;
 Some may question faith.
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Key Concepts of Disaster
Reactions
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Small percentage will have severe adverse
emotional, psychological, or substance
use/abuse reactions;
Very few progress into diagnosable mental
health or substance abuse conditions;
People typically do not seek mental health or
substance abuse treatment services (self-reliance
at all costs, stigma issues, reliance on faith
alone); and
Survivors often reject help (“others need it more
than I do”).
At-Risk Populations
(Potential Risk Groups)
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Children, Youth, and Adults with Children;
Older Adults;
People with Serious Mental Illnesses;
People with Disabilities;
Special Socioeconomic Groups;
First Responders/Public Safety Workers;
and
People with a History of Substance Abuse.
Being Your Own Best Advocate:
It’s Okay to Take Care of Yourself
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Dealing with persons and clients in a crisis
is very stressful;
Dealing with bureaucracies and other aid
groups in a crisis can also be stressful;
Prioritize recovery tasks to reduce stress;
Maintain good lines of communication with
other groups and agencies;
Assist co-workers and staff in using skills
such as communication techniques,
problem solving, conflict resolution, and
stress management.
Dealing with the Weight of Disasters
For some crisis volunteers and
workers, disasters  May trigger memories of previous
disasters or other trauma;
 May cause spiritual exhaustion;
 Old negative behaviors may
reappear.
Disaster Recovery Combats
Negative Reactions
 PTSD;
 Flashbacks
and Reliving;
 Unhealed Grief;
 Inappropriate Spirituality;
 Cumulative Effect of Crisis Work.
Importance of
Co-Worker/Peer Support
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Exchanging information on life
situations helps develop new ways of
adapting (turn to your right, give that
person your business card);
Increasing social support network helps
develop better relationships;
Sharing of similar stories helps to
normalize each other’s experience.
Isolation does not work!
Ways to Encourage Recovery
Reminder that faith is an avenue of
recovery;
 Foster support systems with friends and
family;
 Exercise, diet, and healthy sleeping
patterns;
 Humor is good;
 Take a mental health day.
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Community Support
• Community gatherings, memorials, and
rituals promote recovery;
• Sharing with others who have similar
experiences lessens the burden;
• Participating in the natural community
recovery process, sometimes by just being
a “compassionate presence” aids healing;
• Acknowledging that there are many
spiritual paths to recovery respects
diversity.
Types of Disaster Reactions
 The
following are some kinds of
individual reactions that may be
experienced by disaster survivors:
Physical;
 Emotional;
 Cognitive; and
 Behavioral.
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Physical Reactions
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Gastrointestinal problems;
Headaches, other aches and pains;
Weight loss or gain;
Sweating or chills;
Tremors or muscle twitching;
Being easily startled;
Chronic fatigue or sleep disturbances; and
Immune system disorders.
Positive Responses include alertness and
activation.
Emotional Reactions
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Feeling heroic, euphoric, or invulnerable;
Denial;
Anxiety or fear;
Depression;
Guilt;
Apathy; and
Grief.
Positive Responses include feeling
challenged, involved, and pressured to
act.
Cognitive Reactions
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Memory problems;
Disorientation and confusion;
Slow thought processes, lack of concentration;
Difficulty setting priorities or making
decisions;
Loss of objectivity;
Recurring dreams or nightmares or flashbacks;
Preoccupation with disaster;
Avoidance; and
Questioning spiritual beliefs.
Positive Responses include determination,
sharper perception, and fearlessness.
Behavioral Reactions
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Increase or decrease in activity level;
Substance use or abuse (alcohol and/or drugs);
Difficulty communicating or listening;
Irritability, outbursts of anger, frequent
arguments;
Inability to rest or relax;
Decline in job performance, absenteeism;
Frequent crying;
Hyper-vigilance or excessive worry; and
Avoidance of activities or places that trigger
memories.
Positive Responses include affiliation, helping
response, and altruistic behavior.
When to Seek or Recommend
Professional Help
Some possible indicators for more professional help
are:
 Poor work or family relationship functioning;
 Suicidal thoughts;
 Alcohol or drug use/abuse;
 Phobically avoiding important situations;
 Auditory, visual, tactile, or olfactory hallucinations,
paranoia, or delusions;
 Severe sleeping problems and/or panic attacks;
 Doesn’t feel like eating or getting out most days;
 Can’t stop thinking about the event;
 Can’t enjoy life at all; and
 Acting very differently from before the trauma.
When Is Professional Care Urgent?
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Person has suicide plan and/or means;
Person has homicidal ideation plan and
intent/means to harm others;
Functioning is so poor that person’s (or
dependent’s) safety and welfare is
endangered;
Excessive substance use puts person or
others at risk; and
Severe psychiatric symptoms (such as
psychosis or major depression).
When is Faith Questioned ?
Disaster equals loss and upheaval.
Survivors suffer loss of safety and
security, loss of property, loss of
community, loss of a job, loss of status,
loss of health, home, pets, friends, or a
loved one.
The recovery process through mourning
and grief may involve questioning of
faith. This is normal behavior.
Some Stages of Grief
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Denial – It can’t be true!
Anger – Powerlessness.
Depression - Loss, grief and detachment.
Acceptance – Looking toward the future.
The normal process of
mourning takes several
months or even years.
Sudden Death
No preparation, unfinished business
 No goodbye
 Can overwhelm the survivors
 Sense of unreality
 Search for the reason
 Sense of helplessness
 Feelings of rejection & abandonment
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Informing a Person of Death
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Only about 50% of the
persons who die each year
do so in a hospital.
The rest leave survivors who are informed
of the death by neighbors, friends, family,
caregivers, police officers, clergy, etc.
 All of us may have to do this task at some
point, and not just during a disaster.
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Protocol for Disaster Personnel
(Iowa State Model)
Speak in a private area.
 Notify the parent, partner, or child in
person.
 Whenever possible, go with another
volunteer, policeman, clergy, family
member, etc.
 Deliver the news as soon as possible once
identity has been positively established.
Do not wait until morning.
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Protocol, continued
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Use plain, direct language. Say “dead, died, was
killed”, not “passed away” or “fatally injured”.
Refer to the deceased by name, not “the body.”
Show compassion. Expression of grief may
take many forms.
Remain with the family for at least 30 minutes,
but not so long as to intrude on a very private
time.
Answer questions if asked, but do not speculate.
Speak in a clear and sympathetic way. Leave a
written phone number for follow-up contact.
Disasters Do Not Discriminate
 Everyone
is affected.
 It does not matter where you live.
 It does not matter who your
Higher Power is.
 It does not matter what you do for
a living.
 Everybody suffers.
Men in Disasters
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Immediately after a disaster, care often
focuses on women. Women are more verbal.
Men hurt, too. Men often try to work through
pain alone, in a more private manner.
Men may try to deny their feelings and appear
strong for their families. Pain denied
sometimes translates to anger, negative
behaviors and questioning of faith.
It is important for men survivors not to isolate
themselves, especially from other men.
Women in Disasters
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Surviving a natural disaster lowers the life
expectancy for women more than men.
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The stronger the disaster,
the greater the effect.
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It is important for women disaster survivors
to take good care of themselves, find ways
to reduce stress, make health and therapy
appointments, and develop new social
networks.
Recovery Phase: The Good News
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You have been through a lifechanging event. Healing takes
time. Be patient with yourself
and others.
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There is the potential for posttraumatic growth. About 10% of
disaster survivors will experience
emotional and developmental
growth following a disaster.
Thank You
Funding for this program has been made available by the
American Red Cross Hurricane
Recovery Program
and
United Ways of Alabama
The American Red Cross is especially qualified to be a partner in recovery due to its extensive experience
in responding to major national disasters. The Hurricane Recovery Program (HRP) is committed to
helping survivors on the road to recovery while providing careful stewardship and accountability for the
resources entrusted to it by the American public.
Sheldon L. Rosenzweig, MA, LPC
P.O. Box 2312
Tuscaloosa, AL 35403
205-391-9520
[email protected]
Special Thanks to:
Compassion Coalition of Tuscaloosa County.