Training Module for Behavioral Health Mobilization


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  • This presentation will provide a brief overview of critical factors you need to be aware of to be able to effectively apply your behavioral health skills during the aftermath of disaster and fresh trauma. Later more extensive training may be available; watch and listen for such opportunity. Be sure to read your handouts at your first opportunity. [Recommended handouts: The Deployment Orientation Information Sheet, PowerPoint handout, Psychological First Aid Introduction and Overview handout, others as relevant to the particular incident]
  • This power point is for behavioral health staff who are assigned to work in PODS during mass prophylaxis campaigns. It can be adapted as needed.
  • We will briefly touch upon the following topics: This information will give you the basics that will help you understand your role as a BH responder. Goal of behavioral health response Partners and resources Typical behavioral health impact of disaster
  • We will briefly touch upon the following topics: Interventions used and questions to ask yourself. Special and vulnerable populations and your role in assisting them. Psystart disaster Triage tool. Triage and Urgent Triage Disaster do’s and don’ts Self-care during disaster Orientation to the specifics of the current disaster
  • All of you are part of a much larger team than just behavioral health emergency response: You are not alone at the POD. There are multiple organizations which respond to a disaster. There is a clear chain of command that is known by the leadership of emergency response. Emergency response agencies and organizations coordinate their efforts – they stay in contact with one another, support one another, and provide information for one another that helps facilitate the emergency response process. Every responder has a specifically assigned role and supervisor to report to, which constitutes the glue of the organizational structure. Every POD has a POD supervisor, who is the person in charge of the entire POD operation.
  • Agencies other than the Community Mental Health Program that provide behavioral health support and may be present on this operation include: The American Red Cross is congressionally mandated to meet disaster-related needs. Red Cross Disaster Mental Health workers are licensed mental health professionals who have taken disaster training, and can be found at most disasters. They cover their own service delivery sites and often help out at other settings as well. DOJ and NOVA volunteers are trained to provide short-term interventions for those impacted by criminal events. Disaster Medical Assistance Teams are made up of healthcare professionals, including behavioral medicine professionals, who volunteer to assist during times of major disaster. Peer support groups , such as 12-step groups and the Peer Support Network are currently working with state authorities to integrate their services during disaster. Be sure to coordinate your efforts with other behavioral health responders on site: duplicating efforts can be even more detrimental than leaving gaps, since people repeatedly approached can become retraumatized.
  • ( e.g. if the POD is set up by the county, the county is in charge. If county BH responders are sent to a red cross shelter, the red cross B.H. supervisor is in charge) At times when there are multiple agencies responding to a disaster there can be confusion about who is in charge. The rule of thumb is that the agency standing up the POD is the agency with authority. This means that behavioral health assignments will be made and supervised by the agency in charge.
  • The details of the supervisor responsibility and all other roles are found in the crew leader job action sheets B.H. supervisor (sometimes known as crew leader) will be from the entity standing up the POD. E.g. If the county is standing up the POD the supervisor will be from the county. BH supervisor has someone to whom he/she reports, and can turn to for resources and guidance. BH supervisor will be working with POD site supervisor BH supervisor will be making the BH assignments at the POD.
  • The BH supervisor (crew leader) will make assignment based on number of behavioral health responders available and the needs of the POD. If there are enough B.H. responders, some may be asked to escort people who have been seen in the quiet area to the screening or distribution area, so that they don’t have to go to the back of the line.
  • Assure that BH problems/issues do not impede clinic flow. Primary goal of POD is to medicate or evaluate as many people as quickly as possible. ***Anyone who cannot be contained or is disruptive to the process will be removed As BH responders it is important to be proactive and alert and move quickly to defuse any potential BH problem. Remember – safety first for both the public and providers During a disaster BH responders wear a different hat. We are providing psychological first aid, and referral. We do not do formal therapy or counseling .
  • Essentially everybody is at risk for behavioral health impact. Remember the impact following the Events of September 11th – the whole country was affected. Those who are most directly exposed tend to be most at risk for developing serious conditions following the event, such as PTSD. We need to triage and refer those who were most directly exposed. This is different than our usual task of identifying those with the most acute symptoms. Those most directly exposed Saw/heard death or serious injury of others Death of family member, friend, schoolmate, pet Those less directly exposed even those just watching on TV can be affected. Vulnerable populations: Children- Older adults –persons with disabilities – persons with trauma, substance abuse or psychiatric history There are several types of populations that are considered to be especially vulnerable, such as those with pre-existing conditions, those who are disabled or frail elderly, those with a history of trauma, psychiatric or substance abuse history; (Those with an addiction problem who are new to recovery are at highest risk in this population) those who do not speak English, children; and because of these conditions may need special assistance. Emergency responders: have to deal with too many sad stories, long hours, chaos and stress, frustration with the system.
  • The most usual and expected personal reaction to trauma is application of our psychological resilience : we apply the usual coping strategies that we use during the stresses and strains of daily living to the disaster situation. While we all typically experience unpleasant thoughts or feelings in the face of adversity, peop0le usually cope adaptively. Psychological resilience is not a personality trait, but a process. It represents a set of physical, verbal, and cognitive behaviors that can be taught if they have not been learned by other means. For example: Encourage people to seek social support, and reach out to family and friends. Suggest that people practice good stress management strategies, such as making sure they exercise, eat well, and engage in positive self- talk, such as (“I can get through this;”)
  • It is normal to grieve, to not get the usual pleasure out of life, to be distracted and have decreased concentration, increased irritability. Sometimes just assuring people that these responses are normal can be reassuring. People may have experienced loss. They may be told that they can’t return to their home for a period of time. All of these things would be extremely stressful. Being told to come to a POD, knowing where to go and what’s expected while there, can be confusing at times of high stress. Disasters can impact people in a number of ways. The nature of the disaster will determine the nature of the impact on people and the community.
  • Most people successfully cope by means of usual resilience practices; only a minority become immobilized into a state of crisis; thanks to adrenaline most people become very focused, even those who usually aren’t very focused. Others may need assistance in accessing their natural resilience. A variety of circumstances can result in their feeling overwhelmed: high level of exposure, vulnerable populations, pre-existing behavioral health conditions, other life circumstances already impacting them – such as domestic problems or unemployment. For some, usual resiliency practices are not successfully accessed and applied , and as a result they develop conditions that benefit from traditional professional assistance. If you identify someone who is in need of further support, send them to the quiet area for referral.
  • Disaster mental health is a case-finding process. The vast majority of the time, people will not come looking for B.H. services. The services have to go to them, because: Clients will be focusing on urgent needs, such as establishing physical safety, finding food and water, shelter, medical necessities, clothing, salvaging. In the process they usually do not actively consider their behavioral health status, even when it is interfering with pursuing disaster recovery. Much of disaster mental health intervention is preventive in nature. People typically do not think to take preventive action to protect mental health. Those who are members of vulnerable populations often do not know how to access BH services. Or, they may lack the ability to do so. Cultural attitudes surrounding anything related to mental health carry stigma, and stigmatic attitudes emerge during disaster recovery as well. Those responders who are circulating in the lines want to be alert to people who appear to be in need of further assistance. Talk with them, escort them to the quiet area for further help and referral as needed.
  • Focus on immediate needs – e.g. if someone needs water or a chair to sit down while waiting in line, get it for them. The best disaster workers are flexible and creative. Give reassurance, but don’t over reassure. Let them know that everything is being done to get things under control. Do not give false reassurance. Avoid saying “everything will be alright”, because it may not be. Educate and give appropriate information. Give appropriate handouts. Don’t overwhelm people with too much information. Use everyday language, not psychological or emergency relief disaster jargon.
  • You are BH’s eyes and ears. Observe everyone. Is anyone looking distressed, disoriented, “shut down?” Escort people who are looking distressed or disoriented to the quiet area. Do not use the words “crisis station”. Use other words, like “quiet area, or quiet room.” Tell them where you are taking them (“there’s a quiet area where I can take you to get some further help with this problem. Come with me. I’ll make sure that you don’t lose your place in line.”) Be alert to any stresses in the environment that you might be able to remedy. E.g. Is there a door open that is blowing cold air into the building? Close the door.
  • Behavioral health emergency responders mitigate the impact of a disaster by employing the following general strategies: Stabilize distressed clients, and help them focus toward recovery Remember, goal of the POD is to medicate as many people as quickly as possible. Our first overarching goal, mentioned previously, is to support the smooth working of the clinic, so that as many people as possible can be medicated or evaluated. BH responders should intervene as quickly as possible if someone is becoming aggressive or disruptive. Intervene and try to calm the person who is upset. If this works, they can maintain their place in line. If your attempt to calm them does not work, accompany them to the quiet area for evaluation and intervention. If they become a threat to themselves or anyone else, or if they are disruptive to the work of the clinic, call security. Identify vulnerable populations and address their disaster-related needs, However, be careful not to spend an inordinate amount of time with this population. We must focus on everyone coming to the POD. Educate people with accurate information. Give handouts as directed. Those responders working in the quiet area will have a list of referral sources and educational material. Don’t overwhelm people with too much information. They will be getting information pertaining to medications or other medical instructions when they get to the dispensing area, so we don’t want to give them too much BH information. Give them the minimum that will be useful.
  • Behavioral health emergency responders mitigate the impact of a disaster by employing the following general strategies If your attempt to calm a person who is upset does not work, accompany them to the quiet area for evaluation and intervention. Refer others who need extra support or referral information to the quiet area as well. Help facilitate delivery of other disaster-related services Provide stress management services for responders. ( E.g. if you see a responder who is looking overwhelmed, suggest that they take a break or go get something to eat) Talk to responders in the break room to assess for the need of stress mgt. services or information. Provide behavioral health-related information for the general public
  • Psychological first aid is the intervention of choice for those impacted by disaster. A SAMHSA-sponsored psychological first aid manual can be accessed at this web address. Your “Introduction and Overview” handout comes from this manual. It is applies to anyone who has been exposed to trauma: direct victims, responders, and the public at large. Most psychological first aid interventions can be provided by any caring person. It succeeds because it is designed to enlist the recipient’s own natural psychological resilience. As a basic overview, psychological first aid consists of eight core actions. In this training when relevant they will be described in terms of how they apply to both behavioral-health licensed and non-licensed responders. Read your overview handout at earliest opportunity
  • Much of the distress experienced by those impacted by disaster stems from the chaos and uncertainties. One of the most important components of psychological first aid involves finding out what in particular is distressing to the person and offering information or resources that directly or indirectly addresses the source of the distress. There are three questions you should to be able to answer about an individual at the conclusion of a psychological first aid intervention. These questions are listed in the order in which you should assess and intervene: Is the individual safe, secure, and comfortable? Is the individual functioning adequately Does the individual know what he or she will do next? If the individual is uncomfortable, feels unsafe or insecure, use your problem solving ability to address the particular issue. (For example, if there is a frail elderly person that looks unsafe or uncomfortable standing, escort them through the line more quickly, or if this is not possible, find them a chair. ) If an individual does not appear to be functioning adequately, escort them to the quiet room/area If an individual appears to be functioning adequately, but is confused about what to do next, help them think through “next steps”. Remember, the next steps, might be quite simple, such as preparing and eating a healthy meal when they go home, or call to check on a loved one.
  • Question #1: Is the individual safe, secure, and comfortable? Do they need coffee, water, a chair, information, in order to feel comfortable and secure? Are there physical comfort issues, such as needing coffee, water, a chair, information, in order to be comfortable and secure? Are there health or medication issues that need to be tended to? Anyone who looks like they might be in serious emotional distress should be taken to the quiet area. Certain situations might mandate by-passing the wait line and escorting a person to the first assessment station. People who are handicapped, the frail elderly, someone who appears intoxicated, those who appear to be hallucinating. (check with supervisor to see what situations might necessitate by-passing the wait line and how to expedite this)
  • Question #2: Is the individual functioning adequately? Or is the person emotionally overwhelmed: Upset, withdrawn, lost in angry feelings, confused, is there hyperactivity or hyper vigilance?. Sit and listen if they show a desire to talk. Do not push if they do not seem ready. Everybody has their own pace at which they apply their natural resilience. Pushing can disrupt it and result in poorer adjustment rather than better adjustment. Crisis counseling may be necessary for some. Focus on strengths – an individual’s usual natural resilience. Normalize their experience as being common and expectable following emergency incidents. Ask how they have coped in the past during trying circumstances, and recommend other coping strategies they could try. Psychoeducational materials – offer materials available that describe disaster and coping, or provide other information that meets their needs. Referrals – make referrals when needed, based on the referral number handout and other service-related materials provided at your assignment site. The quiet area should have both educational and referral information. If someone needs to go to quiet area, escort them.
  • Question #3: Is the individual able to develop a plan of action? What will the person do next? Some will benefit from basic problem-solving assistance: Help provide focus: Many will not know where to start, including the fact that they need to begin developing a recovery plan. Help them determine what they need: A new place to stay? Finding out where loved ones are? Health-related or material needs? Help them prioritize: What is most urgent at that point in time? Evaluate options, when possible seek needed information, and select a course of action : List options and discuss their various pro’s and con’s, and establish which option the individual is most comfortable with. Follow-through : What steps will they take to pursue the option to fruition? Remember that first steps of action can be very limited, such as letting one’s head clear or calling a loved one as soon as they get home from the POD
  • When the brain is overcharged emotionally, thinking ability deteriorates. When communicating with someone who is severely overwhelmed: Speak in short sentences and use short, simple words. Use simple directives when you need them to take action. Be clear. Use the person’s name, this helps with getting their attention. Repetition may be necessary, as the information may not get in during the first attempt to communication. Examples: “John, come with me.” “Mary, here’s a chair, sit down.”
  • If clients need more than psychological first aid refer them to the quiet area for stabilization and/or referral. If anyone is threatening to harm self or others, stay with them, call for help. Escort people to the quiet area, if your attempts to calm them are unsuccessful. A person who has lost someone in the disaster, is at high risk for future mental health problems, such as PTSD and should be referred to the quiet area for referral and ongoing care. If you try to reassure and calm someone and they cannot be calmed, escort them to quiet area or call crew leader If someone is behaving erratically or is obviously under the influence of drugs/alcohol, call crew leader In any situation that you feel unable to handle, call crew leader Call security anytime you or anyone else is in danger of being harmed.
  • If clients need more than psychological first aid or basic crisis counseling, facilitate referral: Longer-term counseling or psychotherapy and formal assessments are referred to the quiet area. Staff here will make the referral to the community mental health agency. Psychotropic medication evaluation is also facilitated through the community mental health agency , unless a psychiatric professional is on site for such purposes. Spiritual guidance is provided by referrals through the chaplaincy/ecumenical ministries. Do not try to talk people into utilizing your own spiritual philosophy, no matter how well-meaning. Disaster relief resources become available for meeting a variety of physical and emotional needs. Your direct supervisor or incident commander will be providing information about them as it becomes available. Anyone who checked a “yes” in the shaded area on the PsyStart tool should be taken to the quiet area for referral, since they are at high risk of future behavioral health problems. Anyone who hints or states that they are suicidal or homicidal should be take to a psychiatric facility for in-depth evaluation. Stay with the person, do not let them leave the POD. Contact crew leader for help in facilitating this. B.H. Branch director (located at the EOC) is also a resource to call.
  • For those doing triage and working in the quiet area: During any kind of bio/radiological event, there will be unique fears. There will be confusion about invisible exposure. One cannot determine exposure/risk which leads to uncertainty. Other disasters create other fears. At a POD setting there will be hundreds of people coming through. It will be impossible to screen everyone , however, when an individual comes to the quiet area; or you become aware that someone has lost a loved one due to the event, or saw/heard someone die - Refer to the quiet area, so that they can be referred for ongoing counseling support. Anyone with an injury or illness will need medical triage.
  • PsySTART TM is an evidence based model that identifies those at highest risk for mental health problems such as PTSD following a disaster. It is a color coded tool that is easy to use. Those who check a “yes” item in shaded area, should be referred to appropriate facility or for follow up care care. On the tool, we are looking for the “yes” answers in the shaded area.
  • This triage tool should be available in the quiet area. Depending on the number of BH responders, the crew leader may want to give copies to those doing triage outside the quiet area. Often the responder can fill in the answers based on information already offered during contact with the disaster victim. All answers that are applicable should be filled out. Where someone answers a “yes” in the shaded area, refer them to the quiet area so that appropriate follow-up can be done.
  • All people who check a “yes” in the shaded area should be referred to the quiet area, where referral for ongoing help will be made. The B.H. responder in the quiet area should make the appropriate referral. Make sure that all of the contact information is filled in and correct. BH supervisor will: Help make referral to appropriate facility. Give all of the checked PsySTART tags to the appropriate person at County Mental Health (as appropriate for each county). following the event. During a national disaster, will fax or electronically transmit the PsySTART tag to the PsySTART number listed at the bottom of the page. This information will be further color coded and collated and sent back. The data can be used to obtain FEMA crisis counseling grants. This information will also help those in charge identify locations where there is a high need for behavioral health response and can mobilize resources as needed. For example, there may be a POD with high numbers of vulnerable populations. More BH responders could be dispatched to high need PODS. Psy Start incident command center is only operational during national emergencies
  • Make a rapid assessment: Has any family member, friend, or pet died as a result of the incident? (This person is at high risk. Contact site supervisor and refer to quiet room/area so that referral to the department of mental health for ongoing follow-up can be initiated) Did the person see/hear death or serious injury of others? (This person is at moderate risk and should be given risk tailored coping information.) Is the person a harm to themselves or others. Stay with the person, contact the BH supervisor immediately, and refer for immediate psychiatric evaluation.
  • If anyone expresses thought/intent to harm self or has thought/intent to seriously harm others, The BH site supervisor should be contacted immediately, and arrangements made for thorough psychiatric assessment. If anyone has given hints of being suicidal or homicidal: Ask directly (but privately): Do you have any thoughts or plans to hurt yourself? If yes, what thoughts are you having? What is your plan? How would you do it? Do you have ________ available? Is there anything that would stop you from carrying this out? Do you have any thoughts or plans about hurting anyone else? What thoughts, plans do you have? How would you do it? Do you have (means) available? Call supervisor if anyone expresses or hints about thought/intent to harm self or others. They need immediate psychiatric evaluation. Someone should stay with them until they are taken for a full psychiatric assessment. If anyone shows signs/symptoms of psychosis: hearing voices, seeing visions, talking rapidly with little continuity of content: Anyone showing signs of severe depression, Signs/symptoms of dementia, Contain and refer .
  • This is not in depth therapy or counseling. The goal is to help the individual achieve equilibrium as quickly as possible. We are helping people get back to their normal state of resiliency. Remember, a plan of action can be very simple, such as calling a support person when they get home.
  • We want to normalize their feelings and fears. Help them identify their emotions. Help them look at how they have coped with difficulty in the past. What else could they do. A plan of action is a first step in this process. For example, what would be the most supportive thing you could do for yourself now? Is it call a loved one, have a warm meal when they go home, eat a hot meal? Make this step concrete. First step action plan might be very limited.) Make sure that people have referral numbers and contact and educational information before leaving the quiet area.
  • Disaster response can be chaotic. There are always unexpected and unpredictable things that happen. Things will be organized within a chaotic environment. People coming to a POD will be dealing with all kinds of life events, not just the disaster. If you see someone who is upset, don’t automatically assume it is disaster related. E.g. Someone could have just gotten a difficult diagnosis that is totally unrelated to the disaster. We can’t know how someone else feels, nor can we know if “everything will be alright”, so we want to avoid false assurances. However, we want to give reasonable assurances: “ we’re doing everything we can to take care of …” Make sure that the information you give is true and documented. E.g. You have been told to tell people that the wait will be approximately ___ from this point.
  • Whenever you are unsure of how to proceed, ask your supervisor. While you will need to be flexible and spontaneous as a responder, make sure you remain within the scope of your job action sheet. You will be affected by the disaster as well as everyone else. Our ability to remember what is said greatly decreases when we are under stress. Be sure to ask for clarification, or for repetition of information as necessary.
  • Self care during disaster response is critical, especially if you are involved for more than a day or two. Eat well : Eat healthy foods. During a high energy response you will probably need more calories, so occasional “comfort foods” are not out of place. However do not make drastic changes in your eating habits at this time regardless of how “good” or “bad” your usually diet may be. Drink water : Becoming dehydrated impairs thinking ability. Take breaks: Stepping away from the stress and chaos for even just a few minutes will help clear your head. Find opportunities for exercise: Engage in your usual exercise practice during off-work hours, or take a brisk walk during break periods. This will use up the excess adrenaline that if left unutilized could become detrimental. Get sufficient sleep : Devote sufficient time for sleeping so that you can come back to the response operation fully rested. Limit caffeine and alcohol: Both interfere with sleep; in excess both can impair performance. Monitor yourself, recognize when you are in need, and seek personal support: Pay attention to how you are feeling and when you are feeling overwhelmed, and take steps to manage the stress, in whatever form your personal resilience practices usually handle it. QUESTIONS?
  • Turn to your Orientation Handout. [cover the material on the handout, providing what is known] The presenter should give an overview of the current situation.
  • This information is found on the Mobilization Training CD. Job action sheets Overview of psychological first aid Pocket tips for B.H. responders How to deal with difficult behaviors at a POD When to refer for Mental Health Services, educational handouts for adults and children PsySTART triage tag
  • Training Module for Behavioral Health Mobilization

    1. 1. Mobilization Training Behavioral Health Emergency Response During a large scale Public Health field operation* *This power point has been modified from Oregon’s Behavioral Health All Hazards Response Plan This presentation developed January, 2008
    2. 2. Disaster Activation <ul><li>FOR LARGE SCALE PUBLIC HEALTH FIELD OPERATIONS </li></ul>
    3. 3. Overview – What You Will Learn <ul><li>Goals of behavioral health response </li></ul><ul><li>Our partners/resources </li></ul><ul><li>Typical behavioral health impact of disaster </li></ul>
    4. 4. What You Will Learn, (cont.) <ul><li>Interventions: Self-check questions </li></ul><ul><li>Crisis communication guidelines </li></ul><ul><li>Needs of Special/vulnerable populations </li></ul><ul><li>Disaster do’s/don’ts </li></ul><ul><li>Triage/Urgent triage and PsySTART TM tool </li></ul>
    5. 5. Overview of Response Organization <ul><li>Emergency agencies coordinate effort </li></ul><ul><li>All responders have assigned roles and supervisors </li></ul><ul><li>Every site has a site supervisor </li></ul>
    6. 6. Typical Behavioral Health Disaster Partners <ul><li>American Red Cross (ARC) </li></ul><ul><li>Department of Justice (DOJ) Victims Assistance and National Organization for Victims Assistance (NOVA) </li></ul><ul><li>Disaster Medical Assistance Teams (DMAT) </li></ul><ul><li>Peer support groups </li></ul>
    7. 7. BH Command Structure <ul><li>The entity standing up the SITE is in charge </li></ul><ul><li>BH assignments are made by agency in charge </li></ul>
    8. 8. BH Command Structure <ul><li>Each Site has a BH supervisor </li></ul><ul><ul><li>He/she has chain of command reporting responsibilities </li></ul></ul><ul><ul><li>Works with site supervisor </li></ul></ul><ul><ul><li>Makes assignments to BH staff </li></ul></ul>
    9. 9. BH Command Structure & Roles <ul><li>BH supervisor oversees: </li></ul><ul><ul><li>Triage and Assessment Responders </li></ul></ul><ul><ul><li>Comfort Care Responders </li></ul></ul><ul><li>Assigns responders to: </li></ul><ul><ul><li>Quiet area </li></ul></ul><ul><ul><li>Circulate the line to triage and assess </li></ul></ul><ul><ul><li>Assist vulnerable populations </li></ul></ul>
    10. 10. <ul><li>Assure that people with behavioral health issues do not impede flow </li></ul><ul><li>Mediate the behavioral health impact of disaster </li></ul><ul><li>Establish safety and security </li></ul><ul><li>Provide psychological first aid, not formal therapy and assessments </li></ul>Primary Goals of Behavioral Health Response
    11. 11. Who is at Risk for BH Impact? <ul><li>Those most directly exposed </li></ul><ul><ul><li>Saw/heard death or serious injury of others </li></ul></ul><ul><ul><li>Death of family member, friend, schoolmate, pet </li></ul></ul><ul><li>Those less directly exposed, and the public at large </li></ul><ul><li>Vulnerable populations </li></ul><ul><li>Emergency responders </li></ul><ul><li>Nobody exposed to disaster </li></ul><ul><li>is left untouched by it </li></ul>
    12. 12. <ul><li>Psychological Resilience </li></ul><ul><li>“Psychological resilience” is natural ability to adapt well </li></ul><ul><li>Unpleasant thoughts or feelings occur but people typically cope well </li></ul><ul><li>It is a process, not personality trait, and can be taught </li></ul>Most Usual and Expected Personal Reaction?
    13. 13. <ul><li>Psychological Resilience </li></ul><ul><li>Most survivors cope but effectiveness is diminished </li></ul><ul><li>Disaster stress is normal response to an abnormal situation </li></ul><ul><li>Emotional reactions may stem from problems of living brought about by disaster </li></ul><ul><li>Disaster assistance can be confusing to disaster survivors </li></ul>Most Usual and Expected Personal Reaction?
    14. 14. Psychological Resilience During Disaster <ul><li>Most people manage disaster by usual means of coping </li></ul><ul><li>Some benefit from assistance in accessing/applying their natural resilience </li></ul><ul><li>A minority are not successful and may require traditional professional assistance </li></ul>
    15. 15. A Case-Finding Approach to Response is Needed Because… <ul><li>Clients focus on urgent needs first </li></ul><ul><li>They may not recognize when their behavioral health status is becoming a problem </li></ul><ul><li>People do not think to take preventive action to protect mental health </li></ul><ul><li>Vulnerable populations often do not know how to access BH services </li></ul><ul><li>Stigma! </li></ul>
    16. 16. A Case-Finding Approach to Response is Needed <ul><li>Be proactive </li></ul><ul><ul><li>Focus on immediate needs </li></ul></ul><ul><ul><li>Be innovative in helping </li></ul></ul><ul><ul><li>Give reassurance, but don’t over reassure </li></ul></ul><ul><ul><li>Educate and give appropriate information </li></ul></ul><ul><ul><li>Use everyday words, not jargon </li></ul></ul>
    17. 17. A Case-Finding Approach to Response is Needed <ul><li>Observe and assess constantly </li></ul><ul><li>Is anyone looking distressed? disoriented? </li></ul><ul><li>Who needs reassurance? </li></ul><ul><li>Are there stressors in the environment that can be reduced? </li></ul><ul><li>Does anyone need to be referred to quiet area? </li></ul>
    18. 18. Goals of Intervention <ul><li>Stabilize distressed clients, help them focus toward recovery </li></ul><ul><li>Identify vulnerable populations and address needs </li></ul><ul><li>Provide education and referral resources </li></ul>
    19. 19. Goals of Intervention <ul><li>Refer to quiet area as needed </li></ul><ul><li>Provide stress management services for responders </li></ul><ul><li>Provide behavioral health educational information </li></ul>
    20. 20. Psychological First Aid <ul><li>Represents the current intervention standard endorsed by experts </li></ul><ul><li>Helps anyone exposed to trauma </li></ul><ul><li>Most interventions can be provided by any caring person </li></ul><ul><li>Promotes application of the receiver’s natural psychological resilience </li></ul>
    21. 21. Responder Intervention Self-Check Questions <ul><li>At the conclusion of psychological first aid you should be able to answer the following: </li></ul><ul><ul><li>Is the individual safe, secure, and comfortable? </li></ul></ul><ul><ul><li>Is the individual functioning adequately? </li></ul></ul><ul><ul><li>Does the individual have a plan of action? </li></ul></ul>
    22. 22. #1 Safe, Secure, & Comfortable? <ul><li>Are they physically comfortable? </li></ul><ul><li>Are there immediate health/medication needs? </li></ul><ul><li>Do they need to be taken to the quiet area? </li></ul><ul><li>Do they need to by-pass the wait line and be escorted to the first station? </li></ul>
    23. 23. #2 Functioning Adequately? or Emotionally Overwhelmed ? <ul><li>Listen, if people show desire to talk; </li></ul><ul><li>do not push if not ready </li></ul><ul><li>Focus on strengths </li></ul><ul><li>Offer psychoeducational materials as appropriate </li></ul><ul><li>Make referrals as appropriate </li></ul><ul><li>Escort to the quiet area as needed </li></ul>
    24. 24. #3 Plan of Action <ul><li>If amenable, provide problem-solving assistance: </li></ul><ul><ul><li>Help provide focus </li></ul></ul><ul><ul><li>Ask what is needed </li></ul></ul><ul><ul><li>Help prioritize a specific issue </li></ul></ul><ul><ul><li>Evaluate options, help find information, select a course of action </li></ul></ul><ul><ul><li>Establish follow-through </li></ul></ul><ul><ul><li>REMEMBER, FIRST STEPS OF ACTION </li></ul></ul><ul><ul><li>CAN BE VERY LIMITED </li></ul></ul>
    25. 25. Communicating With Those Who Are In Crisis <ul><li>Speak in short sentences, use short simple words </li></ul><ul><li>Use simple directives </li></ul><ul><li>Be clear </li></ul><ul><li>Use the person’s name </li></ul><ul><li>Repetition may be necessary </li></ul><ul><li>Remember, your thinking processes may be affected as well </li></ul>
    26. 26. Get Help Immediately Modified from: *From Capital Area American Red Cross Chapter <ul><li>If a person: </li></ul><ul><li>Hints or threatens harm to him/herself or others </li></ul><ul><li>Cannot be calmed after attempts to comfort & reassure </li></ul><ul><li>Behaves erratically, exhibits questionable judgment, because he/she is under influence of alcohol or drugs </li></ul><ul><li>Acts confused/disoriented, saying or doing things that do not make sense in the context of the situation </li></ul><ul><li>Whenever problem is beyond your capabilities </li></ul><ul><li>If someone has lost someone due to the disaster, refer to quiet area </li></ul>
    27. 27. In Quiet Area: Refer <ul><li>Anyone who checked a “yes” in shaded area on PsySTART TM tool </li></ul><ul><li>Those needing: </li></ul><ul><ul><li>Longer-term counseling </li></ul></ul><ul><ul><li>Formal assessments </li></ul></ul><ul><ul><li>Psychotropic medication evaluation </li></ul></ul><ul><ul><li>Spiritual guidance </li></ul></ul><ul><ul><li>Disaster relief resources </li></ul></ul>
    28. 28. Triage <ul><li>Make a rapid assessment of: </li></ul><ul><ul><li>Traumatic exposure </li></ul></ul><ul><ul><li>Traumatic loss </li></ul></ul><ul><ul><li>(Use PsySTART TM triage tool) </li></ul></ul><ul><li>Post event resource loss/stress </li></ul><ul><li>Injury/illness (self/family) </li></ul><ul><li>Contain and refer </li></ul>
    29. 29. PsySTART TM Rapid Triage <ul><li>Measures a combination of acute exposure, </li></ul><ul><li>traumatic loss, secondary stress </li></ul><ul><ul><li>Looks at what happened to the person, not their symptoms or mental health per se </li></ul></ul><ul><ul><li>Is a system that identifies those at highest risk for mental health problems following a disaster </li></ul></ul>
    30. 31. PsySTART TM Triage Tool <ul><li>For “yes” answers checked in lower right box: </li></ul><ul><ul><li>Contact County Mental Health to initiate referral </li></ul></ul><ul><ul><li>Provide enough information, so that the CMH can locate individual later </li></ul></ul><ul><ul><li>Give the client County Mental Health contact Information </li></ul></ul><ul><li>For “yes” answers in the shaded main section: </li></ul><ul><ul><li>Notify crew leader for help in initiating referral to appropriate facility </li></ul></ul><ul><ul><li>Crew leader will send copy to PsySTART TM Incident Command Center </li></ul></ul>
    31. 32. Triage <ul><li>Those who have had family, friend, or pet die and/or </li></ul><ul><li>Those who saw/heard death or serious injury of others: </li></ul><ul><ul><li>Are at risk for long term disorders and </li></ul></ul><ul><ul><li>should be referred for ongoing help </li></ul></ul><ul><ul><li>* Research shows that these indicators are more important than symptoms or distress indicators </li></ul></ul>
    32. 33. Urgent Triage <ul><li>Danger to self or others </li></ul><ul><li>Suicide/self harm </li></ul><ul><li>Homicide/harm to others </li></ul><ul><li>Inability to care for self </li></ul><ul><ul><li>Psychosis </li></ul></ul><ul><ul><li>Severe depression </li></ul></ul><ul><ul><li>Dementia </li></ul></ul><ul><li>Thought </li></ul><ul><li>Intent </li></ul><ul><li>Plan </li></ul><ul><li>Lethal means </li></ul>Danger - Assess
    33. 34. Crisis Intervention Steps <ul><li>Establish rapport, and willingness to help </li></ul><ul><li>Conduct rapid triage assessment using PsySTART TM tool </li></ul><ul><li>Conduct urgent triage for suicidality, homicidality, psychosis, dementia </li></ul><ul><li>Call site supervisor if “yes” on shaded area checked on PsyStart TM </li></ul><ul><li>If no shaded “yes” items checked: Help person establish plan of action </li></ul>
    34. 35. Crisis Intervention Steps (cont.) <ul><li>Deal with feelings/fears </li></ul><ul><ul><ul><li>Normalize </li></ul></ul></ul><ul><ul><ul><li>Validate and identify emotions </li></ul></ul></ul><ul><li>Explore alternatives </li></ul><ul><ul><ul><li>What has helped in past? </li></ul></ul></ul><ul><ul><ul><li>Suggest new coping options </li></ul></ul></ul><ul><li>Help client develop action plan </li></ul><ul><li>Give referral information and crisis numbers </li></ul>
    35. 36. Things To Remember <ul><li>Don’t: </li></ul><ul><li>Expect things to be organized </li></ul><ul><li>Assume all problems are disaster related </li></ul><ul><li>Say: “I know how you feel” or “everything will be alright” </li></ul><ul><li>Speculate or offer undocumented information </li></ul>
    36. 37. Things To Remember <ul><li>Do: </li></ul><ul><li>Check with your supervisor when you encounter a situation you can’t resolve </li></ul><ul><li>Ask for clarification when you don’t understand </li></ul><ul><li>Operate only within your assigned job action sheet </li></ul><ul><li>Take care of yourself! </li></ul>
    37. 38. Take Care of Yourself <ul><li>Eat well </li></ul><ul><li>Drink water </li></ul><ul><li>Take breaks </li></ul><ul><li>Find opportunities for exercise </li></ul><ul><li>Get sufficient sleep </li></ul><ul><li>Limit caffeine and alcohol </li></ul><ul><li>Monitor yourself, recognize when you are in need, and seek personal support </li></ul>
    38. 39. Orientation: The Current Situation <ul><li>Nature and extent of the disaster, including safety issues </li></ul><ul><li>State of the response </li></ul><ul><li>Incident-specific concerns and needs </li></ul><ul><li>Likely assignments for this incident </li></ul><ul><li>Materials and referral resources available </li></ul><ul><li>Important contact numbers </li></ul><ul><li>Establish schedule/form of regular communication </li></ul>
    39. 40. Before Deploying <ul><li>Read all of the following information: </li></ul><ul><li>How to Deal with Difficult Behaviors </li></ul><ul><li>Pocket Tips for Behavioral Health Staff </li></ul><ul><li>When to Refer for Mental Health Services </li></ul><ul><li>Psychological First Aid </li></ul><ul><li>PsySTART TM Overview/ Behavioral Health Triage System </li></ul>