Disaster and special populations
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This document discusses special populations affected by disasters and their mental health needs. It outlines several key concepts of disaster impact, including that no one is untouched and there are both individual and collective trauma. It then focuses on specific populations like children, older adults, and people with disabilities or preexisting conditions. For children, it describes common reactions like sleep issues, anxiety and regression that vary by developmental stage. It also lists factors affecting their recovery. For older adults, it discusses their physical vulnerability and environmental stressors, as well as reactions like grief, depression, and withdrawal. It emphasizes their slower recovery and need for assistance accessing resources.
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Disaster and special populations
- 1. Disaster and Crisis MentalDisaster and Crisis Mental HealthHealth Special Populations
- 2. Special PopulationsSpecial Populations •Children and youth •Older adults •People with disabilities •People with serious mental illness •People with low socioeconomic status •Disaster workers •Cultural and ethnic groups
- 3. Key Concepts of DisasterKey Concepts of Disaster ImpactImpact No one who sees a disaster is untouched by it.No one who sees a disaster is untouched by it. – Primary, Secondary and Tertiary victimsPrimary, Secondary and Tertiary victims Two types of traumaTwo types of trauma – Individual (Individual (stress and grief reactionsstress and grief reactions)) – Collective (Collective (Damages the bonds and socialDamages the bonds and social fabric of the community. Increases fatigue,fabric of the community. Increases fatigue, irritability, family conflictirritability, family conflict.).)
- 4. Key Concepts of DisasterKey Concepts of Disaster ImpactImpact • People pull together during and after aPeople pull together during and after a disaster. (disaster. (high activity/low efficiencyhigh activity/low efficiency)) • Stress and grief are normal reactions to anStress and grief are normal reactions to an abnormal situation. (abnormal situation. (transitory reactionstransitory reactions)) • Emotional reactions relate to problems ofEmotional reactions relate to problems of living. (living. (abnormal and excessive disruptionsabnormal and excessive disruptions to daily routinesto daily routines))
- 5. Key ConceptsKey Concepts of Disasterof Disaster ImpactImpact • Disaster relief – can seem complex andDisaster relief – can seem complex and overwhelmingoverwhelming • People typically do not seek out mentalPeople typically do not seek out mental health services (health services (self reliance at all costsself reliance at all costs)) • Survivors reject help (Survivors reject help (others need it moreothers need it more than I dothan I do)) • Mental health services are practical ratherMental health services are practical rather than psychologicalthan psychological
- 6. Key Concepts of DisasterKey Concepts of Disaster ImpactImpact • Services must be tailored toServices must be tailored to community normscommunity norms • Support systems are crucial toSupport systems are crucial to recoveryrecovery • Interventions must be consistent withInterventions must be consistent with the phase of disasterthe phase of disaster
- 7. Physical Reactions to a DisasterPhysical Reactions to a Disaster HeadachesHeadaches Generalized discomfort, hot or coldGeneralized discomfort, hot or cold Hypertension, heart poundingHypertension, heart pounding Gastrointestinal distressGastrointestinal distress Exacerbation of psychiatric illnessExacerbation of psychiatric illness Accelerated physical declineAccelerated physical decline Fatigue or exhaustionFatigue or exhaustion Increase or decrease in appetiteIncrease or decrease in appetite
- 8. Emotional Reactions to aEmotional Reactions to a DisasterDisaster Feeling depressed or sadFeeling depressed or sad Feeling irritable, angry, resentfulFeeling irritable, angry, resentful Experiencing anxiety or fearExperiencing anxiety or fear Feeling despair or hopelessnessFeeling despair or hopelessness Being apatheticBeing apathetic Feeling overwhelmedFeeling overwhelmed
- 9. Cognitive Reactions to aCognitive Reactions to a DisasterDisaster Trouble concentrating or rememberingTrouble concentrating or remembering thingsthings Difficulty making decisionsDifficulty making decisions Preoccupation with the eventPreoccupation with the event Recurring dreams or nightmaresRecurring dreams or nightmares Questioning spiritual beliefsQuestioning spiritual beliefs
- 10. Behavioral Reactions toBehavioral Reactions to DisasterDisaster • Isolation from othersIsolation from others • Sleep problemsSleep problems • Increased conflicts with familyIncreased conflicts with family • Hyper-vigilance, startle reactionsHyper-vigilance, startle reactions • Avoiding remindersAvoiding reminders • Crying easilyCrying easily • Not eatingNot eating
- 12. Risk Factors for ChildrenRisk Factors for Children Exposure to direct life threat andExposure to direct life threat and injuryinjury Witnessing mutilating injuriesWitnessing mutilating injuries Hearing unanswered cries for helpHearing unanswered cries for help Degree of brutality and violenceDegree of brutality and violence Unexpectedness and durationUnexpectedness and duration Separation from familySeparation from family
- 13. Pre-School Age ChildrenPre-School Age Children Sleep problems,Sleep problems, nightmaresnightmares Clinging, separationClinging, separation anxietyanxiety Helplessness,Helplessness, passivitypassivity Death notDeath not permanentpermanent FearfulnessFearfulness RegressionRegression Repetitive playRepetitive play Common Reactions
- 14. School Age ChildrenSchool Age Children Sleep problems,Sleep problems, nightmaresnightmares Preoccupation withPreoccupation with disaster, deathdisaster, death Fears about safetyFears about safety Self blame, guilt,Self blame, guilt, responsibilityresponsibility Angry outburstsAngry outbursts Retelling andRetelling and repetitious playrepetitious play Social withdrawalSocial withdrawal Somatic complaintsSomatic complaints School performanceSchool performance problemsproblems Common Reactions
- 15. Pre-Adolescents andPre-Adolescents and AdolescentsAdolescents Sleep problems andSleep problems and nightmaresnightmares Self blame, guilt,Self blame, guilt, shameshame Self-consciousnessSelf-consciousness Depression, socialDepression, social withdrawalwithdrawal Desire for revengeDesire for revenge Somatic complaintsSomatic complaints Aggressive and risk-Aggressive and risk- taking behaviortaking behavior School performanceSchool performance problemsproblems Common Reactions
- 16. Factors Affecting Children’sFactors Affecting Children’s Recovery From DisasterRecovery From Disaster • Developmental level of childDevelopmental level of child • Pre-disaster mental health of the childPre-disaster mental health of the child • Ability of the community to offerAbility of the community to offer supportsupport • Separation from parentsSeparation from parents • Reaction of significant adults to theReaction of significant adults to the disasterdisaster
- 17. Factors Affecting Children’sFactors Affecting Children’s Recovery From DisasterRecovery From Disaster • Communication between parents andCommunication between parents and childchild • Belief about what caused the disasterBelief about what caused the disaster • The degree of damage/ViolenceThe degree of damage/Violence cause by the disastercause by the disaster • The degree to which the child wasThe degree to which the child was directly impacted by the disasterdirectly impacted by the disaster
- 19. Older Adults Reactions to aOlder Adults Reactions to a DisasterDisaster • Intense sense of grief overIntense sense of grief over mementos, pets, etc.mementos, pets, etc. • Feel unable to start overFeel unable to start over • Past losses re-awakenedPast losses re-awakened • Slower to respond to theSlower to respond to the impact of the lossimpact of the loss • Experience a long termExperience a long term decline in standard of livingdecline in standard of living Impact of Losses for Older Adults
- 20. Older Adults Reactions to aOlder Adults Reactions to a DisasterDisaster • Slower to recoverSlower to recover psychologicallypsychologically and financiallyand financially • Fear of loss ofFear of loss of independenceindependence • DepressionDepression • WithdrawalWithdrawal AgitationAgitation Sleep disturbanceSleep disturbance Memory lossMemory loss Disorientation andDisorientation and confusionconfusion ApathyApathy Stress Symptoms
- 21. Older AdultsOlder Adults Physical vulnerabilityPhysical vulnerability Chronic health conditionsChronic health conditions Medication needsMedication needs Auditory, visual, mobility, or cognitiveAuditory, visual, mobility, or cognitive impairmentimpairment Increase anxiety, confusionIncrease anxiety, confusion Loss of home health supportLoss of home health support
- 22. Older Adults Reactions to aOlder Adults Reactions to a DisasterDisaster • Poor healthPoor health • Need assistance in daily livingNeed assistance in daily living • IsolationIsolation • Poor support systemPoor support system • Limited incomeLimited income Environmental Stressors
- 23. Older Adults Reactions to aOlder Adults Reactions to a DisasterDisaster • Recent losses, or cumulative unresolvedRecent losses, or cumulative unresolved trauma leaves older adults at risk fortrauma leaves older adults at risk for difficulty in coping with disasterdifficulty in coping with disaster aftermath.aftermath. • Successful coping in the past may createSuccessful coping in the past may create a reservoir of skills which increasesa reservoir of skills which increases resilience and adaptability to disasterresilience and adaptability to disaster aftermath.aftermath. Coping Experience and Life Skills
- 24. Older Adults Reactions to aOlder Adults Reactions to a DisasterDisaster • Slower to admit full extent of theirSlower to admit full extent of their losses; may miss deadline forlosses; may miss deadline for applying for assistanceapplying for assistance • Isolation may contribute to lack ofIsolation may contribute to lack of awareness of resourcesawareness of resources • Lack of transportation, limitedLack of transportation, limited mobilitymobility • Tend to under-utilize insuranceTend to under-utilize insurance Utilization of Assistance
- 25. Older Adults Reactions to aOlder Adults Reactions to a DisasterDisaster • Home visits; Thorough assessment of lossesHome visits; Thorough assessment of losses • Assist with recovery of possessionsAssist with recovery of possessions • Suitable residential location/relocationSuitable residential location/relocation • Reestablish social and familial contactsReestablish social and familial contacts • Assist with securing medical and financial aidAssist with securing medical and financial aid • Assist with ways to be involved with communityAssist with ways to be involved with community recovery efforts - volunteerismrecovery efforts - volunteerism Interventions
- 27. People With DisabilitiesPeople With Disabilities • Outreach model helps assure accessOutreach model helps assure access • Provisions must be made to serve:Provisions must be made to serve: Hearing impairedHearing impaired Vision impairedVision impaired Mobility impairedMobility impaired Developmentally disabledDevelopmentally disabled
- 28. People With Mental IllnessPeople With Mental Illness • Same basic needs as everyone elseSame basic needs as everyone else • May have special needsMay have special needs • May “rise to the occasion”May “rise to the occasion” • Program should tailor services to ensureProgram should tailor services to ensure appropriate services are deliveredappropriate services are delivered • Often identify unserved or underservedOften identify unserved or underserved people in completing outreachpeople in completing outreach
- 29. People With Mental IllnessPeople With Mental Illness • Disaster stress reactions may beDisaster stress reactions may be difficult to discern from symptoms ofdifficult to discern from symptoms of mental illnessmental illness • Consumers may be trained as part ofConsumers may be trained as part of the preparedness processthe preparedness process • Should be given the opportunity toShould be given the opportunity to serve the larger communityserve the larger community
- 31. Disaster WorkersDisaster Workers • Emergency Medical ServicesEmergency Medical Services • Law Enforcement/Fire ServiceLaw Enforcement/Fire Service • Emergency ManagementEmergency Management • Voluntary AgenciesVoluntary Agencies • Utility WorkersUtility Workers
- 32. Disaster WorkersDisaster Workers • Train peers when possibleTrain peers when possible • Recognize unique stressorsRecognize unique stressors Conflicting roles (Conflicting roles (family vs. jobfamily vs. job)) Exposure to chaos, death andExposure to chaos, death and destructiondestruction Very long days, exhaustionVery long days, exhaustion Community reactions (Community reactions (hero orhero or scapegoatscapegoat))
- 33. SpecialSpecial PopulationsPopulations Cultural and EthnicCultural and Ethnic GroupsGroups
- 34. Major Racial and EthnicMajor Racial and Ethnic ProportionsProportions Hispanic AmericansHispanic Americans Asian Americans and Pacific IslandersAsian Americans and Pacific Islanders American Indians and Alaska NativesAmerican Indians and Alaska Natives African AmericansAfrican Americans (as described in the Surgeon General’s(as described in the Surgeon General’s report)report)
- 35. Latino/Hispanic AmericansLatino/Hispanic Americans Most Latino/Hispanic Americans share theMost Latino/Hispanic Americans share the Spanish language and other culturalSpanish language and other cultural influences, regardless of whether theyinfluences, regardless of whether they trace their earliest ancestry to Africa, Asia,trace their earliest ancestry to Africa, Asia, Europe or the Americas.Europe or the Americas. Despite these commonalities, there isDespite these commonalities, there is great variability in language use, culturalgreat variability in language use, cultural practices, and the context of immigration.practices, and the context of immigration.
- 36. Asian Americans and PacificAsian Americans and Pacific IslandersIslanders Over 40 different ethnic groupsOver 40 different ethnic groups Fastest growing racial group in the USFastest growing racial group in the US Speak more than 100 languages andSpeak more than 100 languages and dialectsdialects
- 37. American Indians and AlaskaAmerican Indians and Alaska NativesNatives The U.S. Census Bureau estimated thatThe U.S. Census Bureau estimated that 4.1 million American Indians and Alaska4.1 million American Indians and Alaska Natives (Indians, Eskimos and Aleuts)Natives (Indians, Eskimos and Aleuts) lived in the United States in 2000.lived in the United States in 2000.
- 38. African AmericansAfrican Americans Increasing in diversity as greater numbers ofIncreasing in diversity as greater numbers of black immigrants arrive from Africa and theblack immigrants arrive from Africa and the Caribbean.Caribbean. Repercussions from a legacy of discriminationRepercussions from a legacy of discrimination continue to influence their social and economiccontinue to influence their social and economic standing, relations with other groups, andstanding, relations with other groups, and personal outlooks.personal outlooks.
- 39. Special Considerations whenSpecial Considerations when Working with RefugeesWorking with Refugees LanguageLanguage CultureCulture Economic marginalization and differencesEconomic marginalization and differences Fractures social relationsFractures social relations Experience of traumatic stressors and ofExperience of traumatic stressors and of lossloss Family dynamics and role changesFamily dynamics and role changes
- 40. Cultural Differences Cultural differences exist between rural and urban survivors, across differences in education and socioeconomic backgrounds, age groups, and among different religious and non-religious groups.
- 41. Community CultureCommunity Culture The culture of the community provides theThe culture of the community provides the lens through which its members view andlens through which its members view and interpret the disaster, and the community’sinterpret the disaster, and the community’s degree of cohesion helps determine thedegree of cohesion helps determine the level of social support available tolevel of social support available to survivors.survivors.
- 42. Cultural Group InformationCultural Group Information Meanings associated with the eventMeanings associated with the event Experience with emergency responseExperience with emergency response Trauma and violence in country of originTrauma and violence in country of origin Signs and symptoms of trauma, griefSigns and symptoms of trauma, grief View about mental health, providersView about mental health, providers Tips for professional courtesyTips for professional courtesy
- 43. Key Concepts to RememberKey Concepts to Remember • The target population is normalThe target population is normal • Avoid mental health labelsAvoid mental health labels • Be innovative in offering helpBe innovative in offering help • Fit program services into theFit program services into the community contextcommunity context
- 44. Cultural Competence –Cultural Competence – Semantics and ConceptsSemantics and Concepts Cultural diversityCultural diversity Cultural awarenessCultural awareness Cultural sensitivityCultural sensitivity Cultural competenceCultural competence
- 45. Cultural DiversityCultural Diversity The heterogeneity of social class, gender, race, ethnicity and life style present in a neighborhood, community or geographic locale impacted by the disaster.
- 46. Cultural AwarenessCultural Awareness Cultural awareness suggests that itCultural awareness suggests that it may be sufficient for one to bemay be sufficient for one to be cognizant, observant and conscious ofcognizant, observant and conscious of similarities and differences amongsimilarities and differences among cultural groups in order to meet theircultural groups in order to meet their needs.needs.
- 47. Cultural SensitivityCultural Sensitivity Awareness of the various cultural groups affected by the disaster. This includes racial and ethnic groups hardest hit by the disaster, language barriers and people with suspicion of the government.
- 48. Basic Cultural SensitivityBasic Cultural Sensitivity Convey respect, good will, courtesyConvey respect, good will, courtesy Ask permission to speak with peopleAsk permission to speak with people Explain the role of the mental healthExplain the role of the mental health workerworker Acknowledge differences in behavior dueAcknowledge differences in behavior due to cultureto culture Respond to concrete needsRespond to concrete needs
- 49. Cultural CompetencyCultural Competency Awareness of one’s own values and prejudices. Being committed to learning about cultural differences, and being creative, flexible and respectful to others’ values and beliefs in our interventions and outreach approaches.
- 50. Cultural CompetenceCultural Competence Valuing of diversityValuing of diversity Recognition of and respect for differencesRecognition of and respect for differences Understanding cultural definitions of mental health,Understanding cultural definitions of mental health, well-being, coping and recoverywell-being, coping and recovery Use of mental health and other interventions thatUse of mental health and other interventions that “fit”“fit” Services and information provided in primaryServices and information provided in primary languageslanguages Use of empowerment-based approachesUse of empowerment-based approaches Ongoing cultural awareness and sensitivity trainingOngoing cultural awareness and sensitivity training
- 51. Guiding Principles for CulturalGuiding Principles for Cultural Competence in Disaster MentalCompetence in Disaster Mental Health ProgramsHealth Programs Recognize the importance of cultureRecognize the importance of culture Determine the cultural composition of theDetermine the cultural composition of the community; recruit and train disaster workers whocommunity; recruit and train disaster workers who represent the communityrepresent the community – Community profileCommunity profile – Staff recruitmentStaff recruitment – Cultural competence trainingCultural competence training Ensure that services are accessible, appropriateEnsure that services are accessible, appropriate and equitableand equitable
- 52. Guiding Principles for CulturalGuiding Principles for Cultural Competence in Disaster MentalCompetence in Disaster Mental Health ProgramsHealth Programs Recognize the role ofRecognize the role of – help-seeking behaviors,help-seeking behaviors, – customs and traditions for healingcustoms and traditions for healing – customs and traditions in trauma and losscustoms and traditions in trauma and loss – natural support networks.natural support networks. Involve as “cultural brokers” communityInvolve as “cultural brokers” community leaders and groups representing diverseleaders and groups representing diverse groups.groups.
- 53. Guiding Principles for CulturalGuiding Principles for Cultural Competence in Disaster MentalCompetence in Disaster Mental Health ProgramsHealth Programs Ensure that services and materials areEnsure that services and materials are linguistically appropriatelinguistically appropriate – Availability of trained bilingual/bicultural staffAvailability of trained bilingual/bicultural staff – Translation of educational materials andTranslation of educational materials and documentsdocuments – Language and sign-language interpretationLanguage and sign-language interpretation
- 54. Elements of a CulturallyElements of a Culturally Competent DisasterCompetent Disaster PreparednessPreparedness Needs assessmentNeeds assessment Program planProgram plan – OutreachOutreach – Community educationCommunity education – Community networkingCommunity networking – In-Service training and consultationIn-Service training and consultation – School based programsSchool based programs – Anniversary eventsAnniversary events
- 55. Organizational ApproachesOrganizational Approaches Effective management structureEffective management structure Effective managers and supervisorsEffective managers and supervisors Clear purpose and goalsClear purpose and goals Functionally defined rolesFunctionally defined roles Team supportTeam support Plan for stress managementPlan for stress management
- 56. Community OutreachCommunity Outreach Initiate contact at gathering sitesInitiate contact at gathering sites Set up 24-hour telephone hotlinesSet up 24-hour telephone hotlines Outreach to survivors through media,Outreach to survivors through media, InternetInternet Educate service providersEducate service providers Use bilingual and bicultural workersUse bilingual and bicultural workers
- 57. Community InterventionsCommunity Interventions Memorials and ritualsMemorials and rituals Usual community gatheringsUsual community gatherings Anniversary commemorationsAnniversary commemorations Symbolic gesturesSymbolic gestures
Editor's Notes
- Welcome Introductions--name, title, who do you work for?, experience in mental health trauma interventions? Orientation to the day (agenda)