Emotional and Spiritual Care: Beth Goss

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Participants will learn about the importance of post disaster emotional and spiritual care for community stabilization and resiliency. Both psychological and pastoral care will be addressed.

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  • Thank you for coming to this presentation about Emotional & Spiritual Care in Disasters.
  • This presentation is designed to be used in a multi-faith setting, where an audience is drawn from a particular community—primarily Fairfax County Virginia. Some illustrations here are drawn from Fairfax County Virginia, disasters of 2001 through 2013.It is based on similar presentations given through the auspices of Presbyterian Disaster Assistance (PDA) and should not be changed or modified without the express permission of Presbyterian Disaster Assistance.Estimated total time: 20 minutes, plus presentations from Drs. Stratoudakis and Mauer, plus Q&A
  • When planning for the recovery of a community after a disaster, there are lots of things to consider. Some things are obvious – for example, short-term: Provision of utilities, emergency food and shelter, clean up help. Long term: management of building supplies and volunteers.
  • Some things, like Emotional and Spiritual needs are less apparent. Some estimate that for every person affected by a physical loss, there are 60 to 70 other persons who have been effected emotionally or spiritually.[need citation] In cases of human-caused disasters, the multiplier may be even more.
  • Today we want to show you how important Emotional and Spiritual Care is following a disaster, and what you can do to prepare for it. We will also lift up guidelines for delivering it and suggest some strategies for houses of worship and faith communities who want to play a role in the delivery of emotional and spiritual care following disasters.
  • Disasters challenge human functioning on several levels. Physical—people need food and shelter, health care; communities need utilities, roads, schools, and functioning government. But disasters also affect people’s emotional and spiritual selves, because a community-wide disaster…
  • [read slide]
  • We look for recovery in unsettled times, and the description on Page 6 of “Light Our Way” says it very aptly… [Light Our Way available here]The ability of a community to “re-tie” the strands is what we mean by “resiliency.”
  • [Acknowledge source of this chart—Church World Service and PDA] All disasters are unique. However, there are predictable patterns of emotional response that can be anticipated, for individuals as well as whole communities. Emotional healing is not a linear process. Traumaticreminders and even commemorations may move people up and down, back and forth along the recovery process.  The goal of emotional and spiritual care is to help survivors move through the process by accessing natural human resiliency.Care does not mean fixing the disaster, but does mean that both care-givers and care-receivers move through the process by accessing the factors that promote healing and recognizing their own hope and resiliency. Immediately after a disaster there is an emotional high for both individuals and a community. There is a “can do” spirit that insists we can and will get through this.  While this is essential at the time, and ultimately true, the frustrations of recovery and the length of the recovery will usually outlast any human patienceAs the depth of the disaster sinks in and discouragement appears, individuals and the communities will experience short-tempers, sometimes deep conflict, and other symptoms of stress. As persons continue working through the grief, healing effects begin to make the situation improve again. However, there is not straight uphill progress. There will be reminder events: similar disasters, nearby or far away; commemorations, which can either signal hope or cause frustration.Finally, the community reaches the point of long-term acceptance and recovery. In some charts this is referred to as the “new normal”. Things will never be the same. One does not return to normal, but arrives at a new normal, a recovery that accepts the changes and losses as well as the hope for the future.
  • Many people have different definitions of “spirituality” but there are common themes to most definitions, so we will use the term here in a general way.
  • Emotional and spiritual care is as unique as each person. The term “spiritual care” will be used in this presentation to mean helping people connect with their own sources of belonging, meaning, and identity, whether or not “religious.”
  • The 9/11 events caused 3,000+ people to die and 4,000 to be injured. But it was not only they, their families and close friends who were impacted. As you know, the first responder community far and wide was devastated by losses. Caregivers were grieved. So was the faith community, business and government groups, the media. So was I; so were you, I have no doubt. By some counts, 12 million US citizens reported physical and psychological problems to doctors and psychologists in the aftermath of the event. How wide are the ripples of a disaster? In short, on a scale to fit the size of the disaster, everybody is impacted.
  • It is tempting to think that emotional and spiritual care should be “left to the professionals” – pastors, rabbis, priests, imams, etc, or mental health professionals. In some senses this may be true, but there are good reasons why these should not be our only resources. 80% of Americans say they have a religious belief, leaving 20% that don’t. Still, of the 80% that do profess a religious belief, many have no affiliation with any specific faith community. Persons experiencing emotional or spiritual distress may not reach out for help. Their need for help may become evident in unexpected places at unexpected times, meaning that at any time, any person may be called upon to provide ESC.
  • So who does it?
  • In Short – Everyone may give or receive ESC
  • Most people have natural resources for resiliency and will be able to move through a disaster recovery if they have access to the three primary elements for healing: Narrative—that is,the circumstances to facilitate telling one’s story to a present listener, often many timesStrong positive relationshipsTaking care of one’s selfESC consists of fostering these three kinds of capabilities for individuals and communities
  • Narrative:People in extreme fear experience brain changes at a deep, neurological level. Narrative/story telling becomes the process by which the material of the fear and trauma is brought into consciousness, allowing us to think about it, name it, and reveal it. Narrative puts the trauma into the part of the brain that gives us the capacity to deal with it. Narrative allows for us to confront the memory of the traumatic experience. We have words to speak/describe/inform and words for others to hear. Narrative externalizes the trauma, giving it structure and form that can be witnessed instead of remaining in highly-charged sensory fragments that generate symptoms inside us. Narrative gives us permission for truth telling. Sharing of the narrative is the best ritual for recognizing that the trauma is common to the whole community, and thus it restores the survivors’ relationship to the community.
  • The next thing people need to heal from disasters are a set of positive human relationships. This means connecting to people who are supportive as well as limiting or setting boundaries with people who are not.
  • That brings up the final thing people need to heal—Self-care. You are here because you are concerned about others and their challenges caused by the disaster. That tells me that you have empathy, andyou can offer a great deal of encouragement and comfort to other people who are going through troubled times. Just remember that you can do this only if you take care of yourself.You too are vulnerable to the stress others endure.Disasters have a primary and secondary impacts. Most people in a disaster are impacted secondarily.Another complicating factor after disasters is theaccumulation of exposures. The more you are involved, the more tragic stories you hear, the more devastation you see, the more you will be affected.  But you have a gift to offer others. Your gift increases in value when you take care of yourself and are able to function responsibly, lovingly, and supportively… not only for those affected by the disaster, but also for your family and friends who are in your life, who count on you, who need you, who love you. This gift of yourself: only you can preserve it and share it. I repeat: You can give the gift of yourself only if you first take care of yourself. Check out page 43 in Light our Way and learn how to mitigate the Compassion Fatigue to which you have been exposed.  
  • Effective ESC is…1) The ministry of presence2) Not “fix” everything; caregivers are there to encourage and support positive directions and to allow people to vent their frustrations. We are not there to take away their pain, but to support and help them as they work through it.3) Stories need to be repeated multiple times to become “real”. [Ask for examples such as 9/11, or their recent disaster.]ES caregivers can provide a “safe” place, and an outlet for stories which others have already heard (maybe multiple times) or from which the tellers want to spare others. 4) While many come together after a disaster, some people cope with a shaken world by withdrawing. Some may need time alone; some, however, need to be drawn out to let them know that someone still cares, someone notices, that they still have value and meaning to the community. People need to have opportunities created to gather in community – for information, for resources, for support, for fun, for ways to give as well as receive, to remember, and they need encouragement to take advantage of these opportunities.5) Survivors and caregivers often neglect their own care for various reasons: survivor guilt, compassion, heroism, self-denial. Long-Term Recovery Groups need to promote self-care, and provide a system that encourages self-care.
  • Organization and cooperation for ESC is just as important as organizing to provide physical relief after a disaster. ESC is not an option to be discussed after the physical needs of people are addressed. It is integral to the recovery process. It is also NOT a solitary enterprise. In fact, if you think that you are the only one who can offer ESC to survivors after a disaster, you will probably fail.
  • People and organizations that want to be part of the provision of Emotional & Spiritual Care following disasters have to first assess their own situations.Who are we? What do we know best? What can we offer? How can we team with others in healing?Most people will recover on their own – 5-10 % may need professional help. Caregivers must know their limitations and their own unique characteristics that could be helpful to the community: such as familiarity with a neighborhood/culture or ethnic minority; an artistic gift, etc.Need to consider the differences in kinds of referrals (medical, mental health, spiritual) and to keep in mind the special needs of specific religious/spiritual groups and become inter-religiously competent if called upon to deliver ESC outside of one’s own faith tradition.
  • Each group offering to provide ESC in a disaster must assess WHO it is that would be best able to receive your unique kind of care.
  • There are many waysthat individuals and organizations can be involved in the provision of ESC, besides being present to directly affected individuals.People receive lots of information about physical needs: money, rebuilding materials, food and shelter – all of which are important. It is equally important to provide information about emotional and spiritual care.2) Providing information about available Mental Health and Pastoral Counseling Resources3) Holding Commemorative Events at anniversary time
  • Whatever your role, you should be aware of basic standards of care that will help. Handout: NVOAD ESC Points of Consensus There are many well-meaning people who do and have done harm when attempting to provide ESC for survivors of disaster. There are good practices for do’s and don’ts. In brief, don’t dismiss pain; don’t try to explain; don’t argue – Do show care, Do listen. There is a large difference between care to someone from your own community or house of worship, and providing ESC to a stranger in time of disaster. Sometimes ESC providers abuse their intended help-ees by attempting to offer their own faith traditions as an “answer.” However, offering ESC is NOT the same as proselytization andcan even backfire and do harm. Removing the coping mechanisms of a person by shaking their religious foundation and trying to replace them with your own can leave a person without any foundation. Even if the person has no faith tradition, to attempt to provide your own can shake whatever coping mechanism they have used in the past. This does not mean you cannot pray with a person or answer questions about why you are there, doing what you are doing. It does mean that you pray when the person asks or otherwise indicates that they would like to pray; that you ask about their own faith tradition and seek to comply with their tradition as much as possible, and that you answer questions about yourself, not questions about them.Even if they are trained as therapists, Emotional and Spiritual Caregivers shouldnot to act as therapists. If they are not qualified therapists, they surely must not try to do therapy. 4)I urge you to read and share the NVOAD Points of Consensus which represents the collected wisdom of many traditions and experienced providers of emotional and spiritual care in disaster.
  • This Light Our Way page also gives an excellent review of guidelines for delivering Emotional and Spiritual Care.
  • You might encourage your house of worship leadership to become involved with Fairfax Community Chaplains. This organziation has been in existence for about 4 years. It is governed by a steering committee of volunteers who have committed themselves to partnerships in Fairfax County (including the County government office of Emergency Management and Faith Communities in Action. [Fairfax County Faith Communities in Action (FCIA) is a network of faith communities, faith and community-based organizations, and government agencies that promote a respectful, healthy, and caring community through countywide interfaith, government and non-profit organization dialogue. The group is supported by Fairfax County Community Interfaith Coordination within the Department of Neighborhood and Community Services.]
  • Ministerial associations –Disaster care is different from usual pastoral care. Disaster care can also mean support to pastors, who may have suffered from the same disaster, as they in turn care for their congregations and others.Mental health professionals – similar reminders about nature of ESC after disasterTeachers – We do not often think of teachers as being counselors in times of disaster or of disaster recovery. However, other than the children’s parents, teachers spend more time than anyone else with children who are disaster survivors. While these teachers may have to be confidant and consoler of 15-30 children, they themselves may also have been impacted by the same disaster. Community leaders – Most of them have not had training or experience in dealing with disasters but are expected to take the lead in the response and recovery. Training in peer listening for general public – you do not have to have years of training or a professional degree to be able to listen to someone recovering from disaster. However, it is very helpful to have some training to avoid the pitfalls of uncaring listening.
  • In special cases, where the disaster is severe enough and long-lasting enough, communities may need to give special attention to ES Caregivers themselves. Caregivers are among the people least likely to seek help. They invest a lot of their identity in being able to help others, and in being strong. Yet they are also human and have limits. For caregivers to remain most effective, they must be encouraged to seek relief and be trained to recognize the symptoms of compassion fatigue in themselves, as well as in others.  Where a community has established a Long-Term Recovery Group, one function should be to pay attention to the ESC for long-term recovery.Care for Caregivers retreats – Caregivers are given the opportunity to share their experiences in a safe environment, to receive care themselves, and to learn techniques for dealing with stress. Compassion Fatigue may be a new term to some of you.Compassion Fatigue retreats -Caregivers need to be able to assess their own and their co-workers’ levels of stress and compassion fatigue. Compassion Fatigue retreats not only help them to do this, but also provide means and training for avoiding or recovering from compassion fatigue. Long-term recovery groups need to promote and, on occasion, insist on caregivers’ taking advantage of these opportunities. Many denominations provide stress breaks for their clergy. Other fields may have similar programs. The LTRG should be aware of what is available and make sure the caregivers are also aware; they may also wish to schedule such events and support. Grants are sometimes available.Mental health support – By providing information about mental health support, the LTRG can help remove the stigma of seeking mental health assistance. 
  • Specific information about the Community Services Board and the provision of mental health services in Fairfax County.Q&A
  • Emotional and Spiritual Care: Beth Goss

    1. 1. 1
    2. 2. • James P. Stratoudakis, Ph.D., LCP,Director, Office of Quality, Compliance and Risk Management, Fairfax- Falls Church Community Services Board • Charles Mauer, Ph.D., Fairfax-Falls Church CSB Mobile Crisis Unit • Rev. J. Beth S. Goss, M.Div., M.B.A., Pastor, Presbyterian Disaster Assistance, National Response Team
    3. 3. 3
    4. 4. 4
    5. 5.  the role of Emotional and Spiritual Care (ESC) after disaster  Guidelines for good delivery of ESC  Strategies for faith communities and houses of worship  Resources in Fairfax County 5
    6. 6. 6
    7. 7. 7
    8. 8. 8 “A disaster affects the entire fabric of community that existed prior to the event. Disaster Recovery is in large part the rebuilding of community, the re-tying of the thousands of strands of relationship in the fabric of our being together that have been severed by the disaster.” --The Rev. John A. Robinson, Jr.- Light Our Way, p. 6
    9. 9. …time → ←negative…intensity…positive→
    10. 10. • Many Definitions -- Common Elements • The struggle for meaning • The relationship of the human spirit to transcendence and hope. 10
    11. 11. • A broader term than religion or faith tradition • Many choose religion or faith tradition for their source of belonging, meaning, and identity. • Every person has a source of belonging, meaning, and identity whether or not ‘religious.’ 11
    12. 12. 1212 Who needs ESC? Bereaved and seriously injured, those suffering loss of property First Responders Family and close friends Caregivers Faith communities, Business & Community at large Nation & World at Large …in Short, Ever ybody
    13. 13. Who Does Emotional and Spiritual Care? 13
    14. 14. 14 Religious leaders Deacons Stephen Ministers Who Does Spiritual and Emotional Care?
    15. 15. Office Managers Musicians Sextons 15 Who Does Spiritual and Emotional Care?
    16. 16. 16 Members of Groups: Lions Club Torah Reading Group Book Groups Aerobics Classes Who Does Spiritual and Emotional Care?
    17. 17. 17 Friends AND Strangers Who Does Spiritual and Emotional Care?
    18. 18. 18 Parents, Grandparents, Sisters and Brothers Who Does Spiritual and Emotional Care?
    19. 19. Barbers Bartenders Beauticians 19 Who Does Spiritual and Emotional Care?
    20. 20. 20 Teachers and Counselors Who Does Spiritual and Emotional Care?
    21. 21. 21 Receptionists at Houses of Worship, Service Organizations, Government Who Does Spiritual and Emotional Care?
    22. 22. ANYONE who is willing to be present to suffering persons 22 Who Does Spiritual and Emotional Care?
    23. 23. Self-Care 23 Narrative Positive Relationships
    24. 24. • Brings the trauma into consciousness. • Gives us a way to confront the experiences. • Lessens symptoms. • Externalizes it and gives it structure. 24
    25. 25. Family Close Friends Group Connections Listening Partner 25
    26. 26. 26
    27. 27.  Ministry of presence  Accepting/respecting persons where they are  Listening to survivors’ and caregivers’ stories  Encouraging close connection to community  Encouraging self-care 27
    28. 28. How can we organize for Emotional and Spiritual Care? 28
    29. 29. • Your own capabilities • Your own unique contribution • Your own limits. • Your natural partnerships 29
    30. 30. • For Survivors •Individuals and Their Families •Entire Community • For Responders & Caregivers 30
    31. 31.  Educating people through media and training groups  Providing information about available mental health and pastoral counseling resources  Holding commemorative events at anniversary times. What will your role be? 31
    32. 32. See National VOAD Points of Consensus in Delivery of Emotional and Spiritual Care (Spanish and English versions available) 32
    33. 33. • Respect for diverse faith traditions • Concern for confidentiality • Guarding against unsolicited proselytization • Respect for social diversity • Description of professional boundaries that guarantee safety of clients • Mechanisms for ensuring that caregivers function at levels appropriate to their training and educational backgrounds 33
    34. 34. 34 • Interfaith based, • Community volunteers • Commitments to integrity and good practices
    35. 35. • Show up when deployed • Offer ministry of presence • Assess need for referrals and make referrals as appropriate • Medical • Mental health • Spiritual (refer to someone from survivor’s faith tradition) 35
    36. 36. • Training in disaster ESC for groups who serve others • Ministerial associations • Mental health professionals new to disaster work • Teachers • Community leaders • Case managers • Training in peer listening for the general public 36
    37. 37. • Care for Caregivers retreats • Compassion Fatigue retreats • Mental Health Support 37
    38. 38.  James P. Stratoudakis, Ph.D., LCP,Director, Office of Quality, Compliance and Risk Management, Fairfax-Falls Church Community Services Board  Charles Mauer, Ph.D., Fairfax-Falls Church CSB Mobile Crisis Unit 38

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