Crisis Response principles for community disasters.

1. Disaster Response
Chaplaincy
Bukal Life Care & Counseling Center
2013

2. Goal
To prepare chaplains, clergy, and
laypersons for providing crisis
stress defusing and debriefing
ministry interventions during
disasters.
This is an overview... a starting
point for crisis response.

3. What is a Disaster?

Sudden and/or unexpected event

Affects a number of people, a community,
or multiple communities.

Element of danger to those affected...
particularly injury or loss of human life.

Involves economic loss... particularly to
property.

4. Key Points
1. What separates Disaster from
Inconvenience is PERCEPTION of those
affected. They are the judge, not the care
provider.
2. The care provider's role is NOT to return
things “back to normal.” Rather, the role is
to help those affected come to an
acceptable and healthy “new normal.”

5. NOVA Key Purposes of Providing
Crisis Intervention
 Educate people about common crisis reactions
 Provide professional and peer validation
 Defuse the emotional overload caused by crisis
reactions
 Provide focus on how people can begin to cope
positively with the chaos
 Help assess whether people need referrals
 Provide method whereby people can begin to
organize their thoughts

6. NOVA Key Purposes of Providing
Crisis Intervention
 Help individuals begin to address what they are
experiencing now and might experience in the future
 Help victims and survivors begin to think about
what provides meaning in their lives
 Provide affirmation that many confusing reactions
are not uncommon or abnormal
 Reassure survivors that most people can cope well
and encourage them to build on strengths and
adaptive capacities for coping

7. Types of Disasters

Natural Disasters

Man-Made Disasters

Disasters that have both natural and man-
made elements.
This matters, because people ultimately will
deal with “who to blame.” Self? Neighbor?
Outsider? Government? God?

8. Some Things that Commonly Occur
with Disasters

Extensive property damage and financial
loss

Massive loss of life or displacement of
humans and animals

Breakdown of transportation and access.

Interruption of communication and public
utilities.

Social break-down and political confusion

9. Post-Disaster Needs
Two Basic Phases:

Relief. Immediate repair and clean-up
needs. Immediate basic survival needs.

Development. Rebuilding of houses and
community infastructure. Rebuilding
businesses and job development.
Failure to address the Development needs
can perpetuate poverty and dependency

10. Crisis Care Team

Don't Self-deploy. Come by invitation.

Be part of a recognized crisis intervention
team.

Know who is in charge on site, and follow
their direction, and get their permission.
<Review Disaster Response Volunteer
Guidelines>

11. Who are the Victims of Disasters?

Direct Victims: Living in the area of
destruction.

Indirect Victims: Living on the fringes of
the area of destruction. Inconvenienced but
perhaps not devastated.

Hidden Victims: Family and friends of
victims. Also, disaster volunteers,
chaplains, professional caregivers.

12. Types of Victims
Classically, one does Critical Incident Stress
Debriefing, CISD, for disaster response
workers (hidden victims).
For other victims (especially direct victims),
various methods of stress defusing are
used (where focus is more on the now and
future than reliving the past).

13. Prioritization of Care
As a Chaplain or Religious Care Provider,
what needs to be dealt with first?
For purposes of disaster response, we follow
the principles in Maslow's Hierarchy of
Needs.
It is often shown as a pyramid with the idea
that the lower needs on the pyramid must
be met before higher needs can be dealt
with.

14. Maslow's Hierarchy of Needs

15. Hierarchy of Needs
The most foundational is Basic or
Physiological Needs: Air, water, food,
shelter, sleep, body temperature regulation,
emergent medical care, etc.
These must be dealt with at least to some
extent before safety and security can be
dealt with.
<Clarification: Removing the person from
REAL physical danger, is a Basic, not
Safety, Need.>

16. Hierarchy of Needs
After basic needs are dealt with, one can
focus on Safety and Security.
Primarily, this is Subjective. The goal is for
the individual or group to FEEL safe,
secure, stable, and free from anxiety and
fear.

17. Hierarchy of Needs
The next level is Social Needs. This involves
the need for belongingness and affection.
After the disaster, there is a need to
reestablish healthy relationships, and give
and receive affection.
This is vital for individuals, families, and
communities as they develop towards a
“new normal.”

18. Hierarchy of Needs
The higher level needs are Esteem (including
a sense of competence and confidence)
and Self-actualization (reaching the
potential God has given the person, in the
context he or she lives).
These primarily would be dealt with in the
Development phase of disaster response
rather than Relief phase.

19. Stress and Trauma Response
Stress is: “The non-specific response of the
body to any demand made upon it.”
-Hans Selye
Stress sometimes gets divided into
“eustress” (healthy stress that keeps us
learning and growing), and “distress”
(unhealthy stress that is prolonged or
excessive)

20. Trauma
Trauma is “an event outside the usual realm
of human experience that would be
markedly distressing to anyone who
experienced it.” The event may be personal
or vicarious, exposure to human suffering.
-Mitchell and Bray
Trauma produces Distress

21. Trauma Response
Stress prepares our body for “flight or flight”
response. This can be useful and even
necessary to function briefly at peak
efficiency. Distress, due to trauma or a pile-
up of smaller stressors, can have very
negative results in multiple ways.

23. Review Stress Chart
(Handout)

24. Three Common Signs a Person is
Suffering from Trauma
1. Reexperiencing the Traumatic Event. Have
trouble concentrating as they relive or
dream the event.
2. Avoiding Memories of a Trauma. Avoid
anything that reminds one of the trauma.
Avoid talking about the trauma. Become
more socially withdrawn.
3. Being constantly anxious and/or easily
agitated.

25. Three Common Signs a Person is
Suffering from Trauma
Dealing with one who is suffering from trauma
is “Stress Defusing.” This involves a
reduction of anxiety (item 3) through
dialogue with a counselor, allowing victims
to share as much of their story as they they
feel comfortable (item 2), while not pushing
them to relive that experience in their mind
(item 1).
Doing this involves “Story-Listening.”

26. The Art of Story-Listening
-Listen – assimilate and integrate to make
meaning of words
-Provide a sense of privacy
-Maintain confidentiality
-Be present in body and spirit
-Be silent sometimes
-Use reflective empathetic listening
-Respect their story... it is their own.

27. Review Handout on Therapeutic
Communication

28. Crisis Invention Models
It is not recommended to simply “wing-it” or
go into a counseling session with no plan.
Some models/orgs include:
-CISD (Critical Incident Stress Debriefing)
-NOVA (National Organization of Victim
Assistance)
-PFA (Psychological First Aid)
-OSFA (Operational Stress First Aid)

29. CISD
Critical Incident Stress Debriefing is
commonly used. It is quite structured. It was
developed to do debriefing with first
responders (caregivers).
As such, it is not really recommended for use
with direct and indirect victims.

30. PFA/NOVA/OSFA
Each of these have their own strengths and
weaknesses for direct and indirect victims.
We are going to focus on a Modified version
of the stress defusing developed by NOVA.
The modification reduces the risk of
retraumatization--- re-living the event.
However, the following 5-Cs of OSFA can be
useful, so they will be described on the
following slides.

31. 5 C's of Survivor Recovery (OSFA)
Cover
Calm
Connect
Competence
Confidence
-www.usfa.fema.gov

32. 5 C's
Cover: Help people regain a sense of safety
after a traumatic event. May involve moving
them to a safer place, protecting them from
onlookers, or just letting them know you are
there to help.
Calm: Calm victims by being calm oneself,
showing understanding of the situation, and
coaching on how to become calm.
-www.usfa.fema.gov

33. 5 C's
Connect: Help people connect to family,
pets, friends, social support structure.
Competence: Help them help themselves.
Assist them to connect with social services
and resources for self-care.
Confidence: Help them gain a hopeful sense
of the future, reducing guilt and self-blame.
-www.usfa.fema.gov

34. NOVA
2 Forms:
-Group Crisis Intervention (GCI)
-One on One Intervention
Basic Model
-Safety and Security (past)
-Validation and Ventilation (present)
-Prediction and Preparation (future)
<Note: allow victims to share their stories as they see them...
don't pressure them to “relive” experiences.>

35. Elijah and Crisis Care
The story Elijah is instructive. In I Kings 19,
Elijah was physically exhausted after a
great battle of faith and endurance.
Prepared to be declared victor, he finds that
the battle is far from over and must run for
his life to avoid certain death.
This is a clasic crisis. Elijah felt that there was
no one he coud turn to except God. So he
starts running to escape from his
persecutors, and to “find God.”

36. Read I Kings 19:1-18
Safety and Security. Verses 3-9a. Elijah
flees to a place of physical safety (away
from his persecutors), emotional safety (a
cave with no one else around), and spiritual
security (in Mount Sinai... the “mountain of
God”).
God gave him food and drink and
encouraged him to rest so Elijah could go
where he felt safe and secure, but
otherwise did not interfere, blame, or
correct.

37. Read I Kings 19:1-18
Ventilation and Validation. Verses 9b-14
God asks Elijah what he is doing here,
inviting Elijah to “tell his story.” God does
not challenge or condemn what Elijah said.
God demonstrates His power to Elijah but
relates to him with a comforting voice in the
cave.

38. Read I Kings 19:1-18
Prediction and Preparation. Verses 15-18
God gives Elijah new tasks... no more battles.
He gives him a helper who will become his
successor.
Only after giving Elijah a “new normal” and
help for his future, does God correct a
mistaken view... his view of being the only
one faithful to God. There are others...
Elijah's work was not fruitless and he is not
alone.

39. Review and Practice NOVA
“Cheat Sheet”

40. What about Children and Those
with Special Needs
Some people need special care. This
presentation cannot cover all
circumstances. But here are some thoughts
regarding children who have suffered
through a disaster.
<Other groups requiring specialization
include the very aged, and those with
physical or mental disabilities.>

41. Myths about Children and Disaster
Myth #1: Children are better off not knowing.
Children will create answers if not given
answers. They need to know the truth, but
the presentation and scope of the truth
should be age appropriate.
Myth #2: Children forget bad events easily.
Simply not true... most adults remember
bad things from their childhood quite vividly.

42. Myths about Children and Disaster
Myth #3: Boys should not express sadness.
Both boys and girls need to be able to
express the feelings they are having.
However, neither should be pressured to
express feelings before they are ready... or
only in specific prescribed ways.
Myth #4: Living through difficult times makes
you stronger. Questionable. Difficult times
may demonstrate preexisting inner strength
that was not known before.

43. Working with Children
Dealing with crisis with children depends on
age. But some activities can be done that
help instill a sense of SAFETY,
PREDICTABILITY, and CONTROL.
Some things include: Relaxation exercises
and art activities. Additionally, use activities
where the child starts focusing on what they
have and what hope there is in the future.

44. Compassion in Crisis
Demonstrating compassion is being present
in the suffering, sensitive to human
diversity, providing the ministry of care in
crisis.
Demonstrating compassion involves giving
the gift of your undivided attention while
TRYING to understand what they have
been through.
Concern: Compassion fatigue (from burnout
and secondary trauma)

45. “Red Flags” in Crisis Intervention
TRYING TO DO TOO MUCH

Trying to “wing it” with no specific intervention
plan

Trying to convert victims (a crisis is a poor time
psychologically for a major change and an
informed change)

Trying to debate theological issues with
traumatized victims or survivors

Trying to meet spiritual needs without listening to
the physical, emotional, and/or social needs

Trying to answer “why?” questions

46. “Red Flags” in Crisis Intervention
ETHICS/BOUNDARY ISSUES

Guard what has be entrusted to you... Maintain
confidentiality

Respect victim vulnerability. Do not probe too
deep.

Guard personal standards. Don't share much of
your own Personal Information

Don't help TOO much (Decide on your limits).

Don't flirt or have “Dual Relationships”

Don't lie (Instead, give “truth with hope”)

47. What Victims Want to Tell Disaster
Chaplains

Don’t explain

Don’t try to take away my pain

Stay close to me

Remember me when everyone else
has gone back to their normal
routines

48. What Victims Want to Tell Disaster
Chaplains

Listen to my doubts

Don’t be afraid of my anger

Be patient with me

Remind me that this isn’t all there is
to life

49. References
“Crisis Care Chaplain Training Manual.” Virginia Baptist
Mission Board, 2007.
“Helping Child Survivors of Disasters: A Practical Guide for
Caregivers.” IBM, Corporate Citizenship & Corporate
Affairs, 2008.
“Crisis Response Stress Defusing Handy Reminders.”
National Organization of Victim Assistance.
“Divine Intervention: The Flight of Elijah in Dialogue with
Crisis Care” by R. Munson, Bukal Life Care Journal, 2012.
www.usfa.fema.gov