FEMA Crisis Counseling Program

1
FEMA Crisis Counseling Program

• Anthony H. Speier, Ph.D.

2
Definition of a Disaster

• A disaster is an occurrence such as a hurricane,
  tornado, flood, earthquake, explosion, hazardous
  materials accident, war, transportation accident,
  mass shooting, fire, famine, or epidemic that
  causes human suffering or creates human need that
  the victim cannot alleviate without assistance.

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Classification of Disasters

• NATURAL VS HUMAN CAUSED
• DEGREE OF PERSONAL CONTACT
• VISIBLE IMPACT
• SIZE AND SCOPE
• PROBABILITY OF RECURRENCE

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The Federal Emergency Response System

• Human Services Program
• Crisis Counseling Assistance Training
• Cora Brown Fund
• Disaster Housing Assistance Program
• Disaster Legal Services
• Disaster Unemployment Assistance
• Individual Family Grant Program
• Stress Management Program
• Department of Veterans Affairs
• Federal Financial Institutions
• Internal Revenue Service
• Small Business Administration Disaster Loans
• Social Security Administration
• US Department of Agriculture
• Foundations in Disaster Mental Health Operations,
  Unit Two Federal Response to Disasters through
  Human Service Programs, Faculty Manual

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Disaster FactsThe Realities of Disaster Mental
Health Services

• No one who sees a disaster is untouched by it.
  (First hand and second hand victims)
• Two types of disaster trauma
• Individual trauma Stress grief reactions
• Collective trauma Damages the bonds of the
  social fabric of the community. Increases fatigue
  and irritability, family conflict damages family
  ties.

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Disaster Facts Continued

• People pull together during after a disaster
  high activity/low efficiency
• Stress grief are normal reactions to an
  abnormal situation reactions are usually
  transitory.
• Emotional reactions relate to problems of living
  abnormal excessive disruptions to daily
  routines
• Disaster relief second disaster
• People typically do not seek out mental health
  counseling services self-reliance at all costs!

7
Disaster Facts Continued

• Survivors reject help Others need it more than
  I need it.
• Mental health services are practical rather
  than psychological.
• Tailor services to community norms.
• Supportive systems are crucial to recovery
  vulnerable populations.
• Interventions must be consistent with the phase
  of the disaster.

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Critical Disaster Stressors

• Threat to ones life
• Threat of harm to ones family
• Destruction of ones home or community
• Significant media attention
• Witnessing others trauma
• Being trapped or unable to evacuate

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Individual Assistance Recovery Resources
Worksheet
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Crisis Counseling Programs

• What is its purpose?
• Provides support for direct mental health
  services for survivors of major disasters.
• Authority for Crisis Counseling
• The Stafford Act authorizes funds for mental
  health services after a Presidentially declared
  disaster

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Crisis Counseling Programs Continued

• Types of counseling programs
• Immediate Services (1-60 days)
• Regular Services (9 months)
• Areas of special concern
• Specific outreach to high-risk groups such as
  children, elderly, disabled, and disadvantaged.
• Psychotherapy and prolonged clinical
  interventions are inappropriate for this program.
• Consumer advocacy must not be confused with
  emotional support.

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Presidential Declaration Federal Crisis
Counseling Programs

• Immediate Services Plan (0-60 days)
• Due 14 days after disaster declaration date to
  FEMA
• Description of disaster and listing of the areas
  where services will be provided.
• Description of state and local resources,
  capabilities, and why these resources cant meet
  the disaster related mental health needs.
• Description of disaster response activities to
  date
• Needs assessment of persons requiring disaster
  mental health services
• Program plan to meet the needs with special
  attention to high-risk sub-population groups such
  as elderly, children, and persons with
  disabilities (including a training plan.
• Budget and budget narrative justifying expenditure

13
Federal Crisis Counseling Programs Continued

• Regular Services Plan (9 months)\
• Builds on activities organized during the ISP
• Provide status of current response to date.
• Needs assessment
• Indicator data of numbers seen types of
  problems
• Interventions used planned by stage of recovery
• Attention to special population needs
  interventions
• A clear and specific understanding of local
  community needs and recovery status
• A broad based survivor community-level strategy
  that is responsive to changing needs through the
  disaster anniversary date
• A phase down strategy
• Budget justification narrative
• Training and human resource strategy
• Evaluation plan

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The Purpose of Crisis Counseling Immediate
Services Program is to Bring a Systematically
Organized Response to a Significantly
Disorganized Event

• Systemic Multidimensional
• Interagency
• Cross Cultural
• Organized Program Design
• Staffing and Communication Paths
• Focused Outcome
• Strategic Utilization of Resources
• Response Immediate from the event date
• Sixty days post-declaration date.

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Model of for Disaster Intervention Programs

• Cost (Person)
• High
• Low

Recovery Counseling
Individual Family Crisis
Counseling Outreach
Natural Group Crisis Counseling
Community Education Targeted Skill-Building
Courses Gatekeeper Training
Public Information
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Post-Disaster Mental Health Interventions

• Outreach and Casefinding
• Brief Treatment (Group or Individual
• Case Management
• Information and Referral

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Cognitive Reactions to Disaster

• Trouble concentrating or remembering things
• Difficulty making decisions
• Preoccupations with the event
• Recurring dreams or nightmares
• Questioning of spiritual beliefs

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Affective Reactions to a Disaster

• Feeling depressed or sad
• Feeling irritable, angry, or resentful
• Experiencing anxiety or fear
• Feeling despair or hopelessness
• Feelings of apathy
• Feeling overwhelmed

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Behavioral Reactions to a Disaster

• Isolation from others
• Problems with sleep
• Increased conflicts with family
• Hyper-vigilance, startle reactions
• Avoiding reminders
• Easily crying
• Increase or decrease in appetite

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Physical Reactions to a Disaster

• Exacerbation of pre-existing medical conditions
• Headaches
• Hot or cold sensations in body
• Vague, generalized physical discomfort
• Hypertension, cardiovascular conditions, heart
  pounding
• Gastrointestinal distress
• Exacerbation of psychiatric illness
• Accelerated physical decline
• Fatigue or exhaustion

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Key Concepts to Remember

• The target population is normal
• Avoid mental health labels
• Be innovative in offering help
• Fit the program into the community

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Keys to Intervention in a Crisis

• No concept of mental illness
• No classification of people
• Focus on strengths and potentials
• Focus on support structure
• Assumes competence
• Active/directive caregiver
• Program/community fit
• Innovative in helping

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Intervention Strategies

• Learn local norms from community leaders
• Use bi-lingual and bi-cultural staff
• Allow time to gain acceptance in a community
• Be dependable, non-judgmental, respectful
• Recognize cultural variation in expressions
• Provide community education information in
  multiple languages
• Focus on problem-solving and concrete solutions
• Interpret facts, policies, and procedures

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State Level Program Operations Checklist

• Program design
• What is the purpose of the program?
• Does the program design reflect the scope of the
  disaster impact?
• Is the program management and staffing consistent
  with
• The environment and communities
• Socio-demographic norms
• At-risk population needs
• Are multiple levels of interventions incorporated
  into the project?
• Crisis counseling to survivors
• Outreach to individuals and families
• Group and community education about disaster
  recovery
• Are intervention strategies appropriate to the
  phase/stage of disaster recovery?
• Does the program have a common identity across
  all disaster sites?

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State Level Program Operations Checklist Continued

• Data Collection
• Have data collection forms been developed,
  distributed, and staff trained on how to use
  them?
• Are the number and types of persons identified?
  (gender, ethnic/racial status, age/special
  population status)
• Presenting issues for intervention identified?
• Confusion/disorientation
• Agitation/anxiety
• Depression
• Disaster fears
• Acting out/adjustment
• Substance abuse
• Information/referral
• Can the type of assistance needed/provided be
  readily identified?
• Groups served (neighborhoods, schools, disaster
  responders)
• Types of concerns expressed
• Services provided (education, consultations)

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Disaster Coordinator Duties

• Coordinate agency coverage of disaster members
  regular duties while they are in the disaster
  response.
• Decide if teams outside the impacted area need to
  be mobilized and the duration of their response.
• Supervise disaster team operations
• Act as agency contact person for relief agencies
• Plan for transportation, food, and shelter needs
  of disaster team members
• Provide teams with special identification badges
  to identify them as emergency workers.

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Typical Crisis Counseling Outreach Model
Crisis Counseling Staff Assignments Respond to
survivor trauma and grief reactions In-service
training In-home community visits
Outreach Worker Assignments Children
Youth Older Adults High Impact Areas
Note This is a representation of a program
design structure. The actual number of staff and
FTEs is dependent on the scope of the disaster
event. Many ISP/RSG projects use half-time staff
or reassign staff to the Crisis Counseling
Program.
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Qualifications of Disaster Mental Health
StaffExamples of What It Takes

• Ability to remain focused
• Function well in confusing chaotic environments
• Have common-sense and can think on their feet
• Sees problems as challenges not burdens
• Can monitor and manage own stress
• Comfortable with value systems and life
  experiences different from their own
• Initiative and stamina
• Sensitive to cultural issues
• Be adept and creative
• Establishes rapport easily

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Knowledge, Skills, and Attitudes Essential for
Disaster Mental Health Workers

• Understand Human Behavior in a Disaster
• Uniqueness of individual response phases of
  disaster response
• Concept of loss and grief post disaster stress
  and recovery process
• Interventions with Special Populations
• Older Adults, children, people with disabilities
• Cultural groups, disenfranchised persons
• Organizational Aspects of Disaster Response and
  Recovery
• Key roles responsibilities of agencies local,
  State, Federal and volunteer

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Knowledge, Skills and Attitudes Essential for
Disaster Mental Health Workers continued

• Key Concepts of Disaster Mental Health vs
  Traditional Psychotherapy
• Intervention style, assumptions, program design,
  service locale, and purpose
• Appropriate Assistance to Survivors Workers in
  Community Settings
• Crisis Intervention age appropriate
  interventions, debriefing, group counseling,
  support groups, stress management techniquess.

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Knowledge, Skills and Attitudes Essential for
Disaster Mental Health Workers continued

• Community-Level Mental Health Services
• Case finding, outreach, mental health education,
  public education, consultation, community
  organization, advocacy, and use of media.
• Understand Stress Inherent in Disaster Work
  Recognize it Manage it
• The buddy system, regular breaks, good
  nutrition, adequate sleep, exercise, deep
  breathing, appropriate use of humor, defusing
  experiences, debriefing after duties are over.

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Barriers to Successful Communication

• Preoccupation with your own concerns not
  focusing on the persons issues.
• Emotional Blocks situation/ conversation evokes
  unexpected emotions within the helper.
• Hostility being angry with the survivor or a
  carryover from a recent experience can distort
  what you are hearing.
• Past Experience Assuming a been there, done
  that attitude results in less efficient
  listening.
• Performance Expectation feel we need to have all
  the answers when we dont we panic and feel
  helpless or become reactive.
• Mind-wandering fin yourself day dreaming and
  unable to pay attention to what is being said.
• Personalizing interpreting the survivors moods,
  feelings, and comments as being directly related
  to you.

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Some Useful Phrases after a Traumatic Event

• You are safe now (if they actually are).
• It is understandable that you feel this way.
• It must have been really upsetting/ distressing
  to see (hear, feel or smell) that.
• I am sorry that it (the flood, fire, your childs
  death) happened.
• It sounds like you are feeling sad (confused
  overwhelmed, scared, angry, exhausted).
• You are not going crazy.
• Your reaction is a normal (common, frequent,
  typical) response to an abnormal event.
• It wasnt your fault (if you are sure about the
  circumstances).
• Things may never be the same, but they will get
  better and you can get better.
• D.J. DeWolf, 1991

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Clichés Not-So-Useful Phrases

• It could have been worse.
• You can always get another house/ pet/car
• Everything will be all right.
• I know just how you feel.
• You need to get on with your life.
• You will get over it.
• The Lord gives and the Lord takes away.
• You cant question Gods will.
• You were lucky.
• What you have to do is just stay busy.
• Crying doesnt help you have to be strong.
• D.J. DeWolfe, 1991

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Disaster Recovery Outreach ServicesCommon Human
Needs

• To express feelings
• To get sympathetic responses to problems
• To be recognized as a person of worth
• To not be judged
• To be treated as an individual
• To make ones own choices and decisions
• To keep secrets about oneself
• Adapted from Biestek (1957) The Casework
  Relationship and Compton, B., (1989) Social Work
  Processes in Raiff, N.R. (1992) Curriculum for
  Community-based Adult Case Management Training

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Elements of a Helping Relationship

• Purpose Normative, operational, individual
• Concern for others caring and communicating
  caring
• Commitment obligation commitment to a common
  purpose
• Empathy being able to enter into feelings
  experiences of the other person
• Genuineness and congruence consistent and
  openness behaviors consistent with realities
• Adapted from Biestek (1957) The Casework
  Relationship and Compton, B., (1989) Social Work
  Processes in Raiff, N.R. (1992) Curriculum for
  Community-based Adult Case Management Training

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Recommendations for Outreach Workers

• Workers must enjoy people and be confident
• Know how to handle dogs and other pets
  knowledge about animals is good for small talk.
• Convey that you are here to help
• Wear comfortable clothes
• Work in pairs-male/female teams are good
• Follow up on mailings is a nice way to get in

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Recommendations, continued

• There are advantages to having a team that is
  diverse in age, gender, race, a life experience
• Be comfortable being in outside elements
• Develop a script of entry remarks that identify
  who you are and why you are engaging this
  individual in conversation
• Go with whatever the person says following your
  introduction validate the persons feelings
• Adapted from DeWolfe, D.J., (1991) A Guide to
  Door-To-Door Outreach (unpublished paper).

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Disaster Recovery Outreach ServicesTips on
Engagement

• Be open, friendly, caring
• Skillful use of body language
• Use active listening skills
• Establish trust
• Focus on strengths
• Treat secrets and disclosures matter-of-factly
• Dont try to parent or impose your personal
  values
• Keep the conversation on track
• Pace the engagement process
• Be comfortable in talking about disaster
  responses
• Dont be intrusive or mechanistic
• Be creative offer hope
• Adapted from Raiff, N.R. (1992) Curriculum for
  Community-based Adult Case Management Training

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ADULT UNIT II, Southern HRD Consortium for Mental
Health/Center for Mental Health Services
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ADULT UNIT II, Southern HRD Consortium for Mental
Health/Center for Mental Health Services
42
ADULT UNIT II, Southern HRD Consortium for Mental
Health/Center for Mental Health Services
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CRISIS INTERVENTION MODEL

• TUNE IN-EXPLORE-SUMMARIZE-FOCUS-EXPLORE
  ALTERNATIVES RESOURCES-AGREE ON CONCRETE PLAN
  OF ACTION

Volunteer and Information Agency, Inc. 4747
Earhart Blvd, New Orleans, LA, 76125
44
Mental Health Facts and Vulnerabilities of Older
Adults

• Older adults account for more than 25 of all
  suicides
• Males over age75 have the highest suicide rate of
  any age group
• Drug abuse in the form of multiple medications is
  common
• Older adults consume more prescribed
  over-the-counter medications than any other age
  group
• Slower rates of metabolism increases the
  possibility of drug interactions and side effects
• Alcohol consumption is a serious problem

45
Mental Health Vulnerabilities of Older Adults,
continued

• The theme of loss permeates the life of many
  older persons
• Loss of life partner often results in social
  isolation
• Low self-esteem often follows retirement
• Caretaker role of ill spouse can lead to loss of
  ones own lifestyle
• Death of significant others peers is a reminder
  of ones own limited mortality
• Loss of sensory abilities (hearing eyesight)
  can result in symptoms of disorientation and
  paranoia
• Malnutrition and infections can alter body
  chemistry leading to disorientation and confusion
• Adapted from Carol E. Blixen, R.N.

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Older Adults Reactions to Disaster Events

• Environmental Stressors
• Poor health
• Physical disabilities (hearing, sight, mobility)
• Needs assistance in daily living
• Isolation
• Poor support system
• Limited income

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Older Adults Reactions to Disaster Events,
continued

• Coping Experience/Skills
• Recent losses or cumulative unresolved traumas
  leave older adults at-risk for difficulty in
  coping with disaster aftermath.
• Or successful coping in the past may give older
  adults a reservoir of skills that allow one to
  cope with adaptability and resilience

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Older Adults Reactions to Disaster Events,
continued

• Impact of Losses for Older Adults
• Intense sense of grief over mementos, pets,
  plants
• Feels unable to start over
• Past losses re-awakened
• Slower to respond to impact of the loss
• Experience a long-term decline in standard of
  living

49
Older Adults Reactions to Disaster Events,
continued

• Utilization of Assistance
• Slower to admit full extent of their losses-may
  miss deadline for applying for aid
• Isolation may contribute to lack of awareness of
  resources
• Lack of transportation may limit mobility
• Tend to under-utilize insurance

50
Older Adults Reactions to Disaster Events,
continued

• Stress Symptomatology
• Slower to recover psychologically and financially
• Fear of loss of independence
• Depression
• Withdrawal
• Apathy
• Agitation
• Sleep disturbance
• Memory loss
• Disorientation, confusion

51
Older Adults Reactions to Disaster Events,
continued

• Interventions
• Home visits/thorough assessment of losses
• Assist with recovery of possessions
• Suitable residential relocation
• Re-establishing familial social contacts
• Assist with medical financial assistance
• Assist with ways to be involved with community
  recovery efforts.

52
Main Components of Grief Reaction Relevant to
Disaster Workers

• Disbelief
• Initial reaction of grief as one come to terms
  with actual loss
• Questioning
• Seeking reasons for the death
• Making the death believable by knowing its cause
• Anger
• Non-directional and emotional
• Semi-violent
• Guilt/Blame
• Seeking the source of responsibility for the
  disaster or death
• Focused on self, others, or God/fate

53
Main Components of Grief Reaction Relevant to
Disaster Workers

• Desperation
• Avoiding eye contact
• Overwhelmed with resignation/dismay
• Sense of hopelessness
• Powerlessness
• Sense of loss of ability to impact life events
• Increased emotional response
• Multiple feelings of fear, hostility, love,
  guilt/hate
• V.R. Pine, (1996) Social Psychological Aspects
  of Disaster Death. In Living with Crisis After
  Sudden Loss, K.J. Doka, and J.D. Gordon, (Eds.)

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Cultural Sensitivity Disaster Mental Health
Services

• Cultural Sensitivity
• Being aware of the various cultural groups
  affected by the disaster. This includes ethnic
  racial groups hardest hit by the disaster,
  language barriers, and suspicion of the government

55
Cultural Sensitivity Disaster Mental Health
Services, continued

• Cultural Diversity
• Includes social class, gender, race, ethnicity,
  and lifestyle

56
Cultural Sensitivity Disaster Mental Health
Services

• Cultural Competency
• Being aware of ones own values, attitudes and
  prejudices being committed to learning about
  cultural differences, and being creative,
  flexible, and respectful of others values and
  beliefs in our interventions and outreach
  approaches.

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When contacting ethnic groups be sensitive to

• Dominant language/English fluency
• Immigration experience and status
• Family values
• Cultural values and traditions

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A Personal Cultural History

• Questionnaire
• Exercise

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Factors Affecting Differential Response
Recovery to Disaster in Children

• Development level of the child
• Pre-disaster mental health of the child
• Ability of the community to offer support
• Whether or not child was separated from parents
• Reaction of significant adults
• Communication between child and parents
• Belief about what caused the disaster
• The degree of damage/violence caused by the
  disaster
• The degree to which the child was directly
  impacted by the disaster

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Potential Relationships That Comprise the Notion
of Family for Children

• Child to natural parent, direct caregiver, and/or
  guardian
• Child to brothers and sisters, both those in the
  same household and living in other households
• Child to uncle, aunts, cousins, both within and
  distant from the disaster impact area
• Child to significant non-related adults
• Child to the world of their school (teachers,
  staff, and students
• Child to their community of worship (church,
  synagogue, etc.)
• Child to persons in their communities of
  reference (e.g., local neighborhood, village,
  town, city, county, etc.

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Basic Principles in Working with Children

• Be a supportive listener
• Be sensitive to the individuals ethnic and
  racial experience
• Respond in a manner that is consistent with the
  childs level of development
• Be aware of the childs emotional status, is the
  child actively afraid or withdrawn
• Determine if the child is comfortable/ secure
  about his/her current surroundings those of
  his/her parents, other significant
  persons/pets, etc
• Assist the child in normalizing his experiences
• If you dont know what to do or think you are
  making things worse, seek assistance from a child
  specialist or mental health professional.