Mental Health Response Team Early Interventions to Disaster Nancy Pierce, MSW, LCSW Mental Health Cr - PowerPoint PPT Presentation


PPT – Mental Health Response Team Early Interventions to Disaster Nancy Pierce, MSW, LCSW Mental Health Cr PowerPoint presentation | free to download - id: 960cb-YWU5M


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Mental Health Response Team Early Interventions to Disaster Nancy Pierce, MSW, LCSW Mental Health Cr


Mental Health Crisis Consultants. MHRT Project Coordinator. 2. Traumatic Stress ... Self-image/world view can become negative ... – PowerPoint PPT presentation

Number of Views:219
Avg rating:3.0/5.0
Slides: 68
Provided by: david1758


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Mental Health Response Team Early Interventions to Disaster Nancy Pierce, MSW, LCSW Mental Health Cr

Mental Health Response Team Early Interventions
to Disaster Nancy Pierce, MSW, LCSW Mental Health
Crisis Consultants MHRT Project Coordinator
Traumatic Stress
  • Threat, horror, loss
  • Exceeds coping resources
  • Breaks protective defenses
  • Severity related to event being unexpected,
    inescapable, uncontrollable, without meaning
  • Incongruous, intrusive, distressful, unremitting
    memories cognitive/behavioral responses
  • May result in development of stress disorders
  • ASD Acute Stress Disorder
  • PTSD Post traumatic Stress Disorder

Traumatic Stress Theory
  • PTSD is not a normal stress response
  • Trauma event may not be the sole cause of
    post-traumatic stress symptoms
  • Stress response is not a sufficient cause of
    traumatic stress disorders therefore…
  • Efforts to reduce stress alone are not sufficient
    to prevent stress disorders (ASD, PTSD)

Prevalence/Prevention of PTSD
  • Prevention of PTSD focuses on
  • Traumatic experience and/or
  • Cognitive/behavioral response to trauma
  • Not the level of stress experienced
  • Majority require no treatment
  • Focus on resilience vs. reactions
  • ID risk and protective/resilience factors
  • Prevalence of PTSD is much lower than
  • prevalence of trauma

Current Best Practices
  • Support rather than supplant established internal
    and external resources
  • Build resilience and protective factors
  • Watchful waiting
  • Careful, conservative referrals
  • Many tools, no prescriptions

Post-Trauma Distress
  • Immediate reactions to traumatic events can look
    like stress disorder
  • Most reactions fade away over time, less
    frequent, less intense
  • Humans beings are equipped to have negative
    experiences, can learn and grow from them and not
    be debilitated

Common Reactions to Trauma
  • Re-experiencing trauma (cues and triggers)
  • Flashbacks
  • Unwanted thoughts
  • Nightmares
  • Avoidance
  • Reminders of event
  • Talking or having feelings, memories
  • Increased arousal
  • Hyper-vigilance, ? startle response
  • Impatience, irritability/anger

Common Reactions to Trauma
  • Fear and anxiety
  • Guilt and shame
  • Grief and depression
  • ? Intimacy and trust
  • ? Use of alcohol and other substances
  • Self-image/world view can become negative
  • Symptoms of trauma adaptations to traumatic
    event in effort to protect self, our beliefs and
    how we find meaning

Risk Factors for Stress Disorders
  • Already suffering from anxiety and mood
    disorders, mental illness, substance abuse
  • Proneness to experience irritability, depression,
  • Cognitive style/ability or disability
  • Prior trauma/abuse or neglect
  • Family instability
  • Poor/unstable social supports
  • Not engaged with community

Protective Factors
  • Resilience, psychological hardiness
  • Cognitive and emotional stability/ability
  • Positive competent social supports
  • Functional family/home life/role models
  • Involved in community and/or school
  • Self-control, mood management, effective coping,
    problem solving
  • Spirituality or religion
  • Ability to ask, accept and use help

What is Normal?
  • Changes after trauma are normal
  • Major trauma may produce severe problems in
    immediate aftermath
  • Many feel better within 3 months after event
  • Others recover more slowly/some dont recover
    without help
  • Becoming more aware of changes since trauma may
    be the first step toward recovery

Many Traumatized Victims…
  • Dont believe they need help
  • Wont seek out services despite emotional
  • Report better off than others less affected
  • Believe help sign of weakness
  • Prefer to seek informal support from friends and
  • More likely to accept help with problems in
    living than accept mental health counseling

Crisis Response to Communities
  • Practical field application of crisis
    intervention to help persons learn to cope with
    extreme stresses they may face in aftermath
  • Objectives to prevent PTSD, or return to
    pre-disaster functioning have been modified
    since there is no clear evidence as to what early
    interventions help or work
  • Still victims of disasters hope they will return
    to their pre-disaster functioning

Trauma Recovery/Resilience
Processing Trauma Experience
  • Integration of trauma recollections takes time,
    repetition and support
  • Allow time for the natural recovery process to
    occur intermittently and in small doses
  • Use avoidant behaviors as natural way to tolerate
  • Educate family/friends how to be empathic,
    patient listeners
  • ID and accept help/support from family, friends,
    community structures like neighbors, churches,
    schools, support groups

  • Different from recovery or adjustment
  • Capacity to maintain normal functioning despite
  • Successful operation of basic human adaptational
  • Ability to bounce back from crisis
  • Persevere through difficult times

Resilience Factors/Examples
  • Psychological hardiness
  • Confidence, commitment to find meaning in life
  • Belief in benefits from good and bad experiences
  • Shift locus of control from external to internal
  • Cognitive flexibility and acceptance
  • Able to flexibly shift expectations and
  • Active coping style problem solving and managing
  • Engage in physical exercise for mood health
  • Meaning in religion, spirituality, benevolence
  • Positive social support/resilient role models

Promoting Resiliency
  • Resiliency more common than we think with
    uncommon ways to promote it
  • Over-optimism about oneself
  • Repressing/avoiding unpleasant thoughts emotions
  • Moving forward as a necessary life task
  • Use of humor and positive emotions
  • Flexible problem-solving, learning to face fears
  • Resilience is about people reaching out and
    helping each other (altruism)

What Does Help?
  • Focus on practical issues and needs
  • Give accurate, simple info about plans/events
  • Help without intruding or forcing interventions
    when victims arent ready or able to use them
  • Recognize the need for passage of time after
    survival is ensured when people have emotional
    stability/strength to face what was lost
  • Explore risk and protective factors
  • Discuss self-care and strategies to reduce
    anxiety like grounding and relaxation techniques

What Can We Do?
  • Provide active yet calming presence to ID signs
    of distress and immediate needs
  • Bear witness/be present to provide emotional
    ballast/balance and provide advocacy
  • Actively listen, empathize, normalize/reassure to
    help make sense and find meaning
  • Assist in resiliency building by modeling
    positive coping skills effective problem solving

ID Vulnerable Persons
  • Needs may be more complex or intense
  • May exceed traditional services provided
  • Increased susceptibility due to needs
  • Cant access and use standard support resources
    in relief/recovery
  • Higher risk during traumatic chaos, needing
    assistance and services tailored to their needs
  • ID persons with special needs current or past
    trauma, behavioral or emotional disorders,
    impulsive risk behaviors

  • Dependent on adults for security
  • Lack authority/ability to control environment
  • Underreport due to difficulty verbalizing trauma
    experience or downplay feelings
  • Nonverbal signs of distress are mistaken for
    other disorders
  • Traumatic effects more damaging to
    still-developing/malleable minds and alter path
    of childs development
  • Developmental stage in which trauma occurs may
    help predict impact on child

Children and Trauma
  • Children and adolescents are affected by how
    adults closest to them conduct themselves
  • Children thrive on consistency, routines and
    rituals so restore familiar childhood activities
  • Encourage expression of thoughts and feelings by
    talking/explaining what happened
  • Protect children from overexposure to
    graphic/disturbing images, but provide factual
    info in simple and direct language
  • Parents should be encouraged to provide social
    support and keep families united

What Children Need
  • If disoriented/shock, needs 11 support with
    protective adult, parent/family
  • Physical comforts
  • Cuddle toys
  • Blankets for warmth and nesting
  • Snacks for nurturance
  • Repeated concrete explanations about what
    happened, what is going to happen
  • Repeated assurances they are safe/secure
  • Access to materials to play, draw, familiar play
  • Opportunities to talk

Help Children Grieve
  • Advice on loss and death depends on culture,
    religious faith and beliefs of survivors
  • Children often mirror parents responses
  • Depends on age and maturity of child
  • Keep it short, simple and accurate
  • Use patient listening, dont force talking
  • It helps to make it safe for child to grieve
    losses, to know they are not alone in their grief
  • Include children in recovery efforts preparing
    and planning for future

Educate Parents to Help Children
  • Parents most concerned about children who are
  • Parents usually best helpers for children
  • Parents feel helped when they are taught how to
    help their children
  • Parents feel empowered when workers consult and
    advise parents on how to help

How Parents Can Help
  • Model calmness and control
  • Reassure child they are safe
  • Reassure trustworthy people in charge
  • Let child know okay to feel upset/angry
  • Observe childs behaviors
  • Changes in sleep, appetite, etc
  • Tell the truth
  • Stick to the facts
  • Keep explanations age-appropriate
  • Keep explanations brief and simple for young
  • Separate fact from fantasy for older
  • Be a empathic, patient listener

What Parents Can Do
  • Focus child on next day or two
  • Make time to talk with child
  • Stay close to child to reassure and monitor
  • Limit TV time watching disaster
  • Maintain normal routine but be flexible
  • Spend extra time before bedtime
  • Make sure child is eating, sleeping, being active
    to ? stress
  • Offer prayers, thinking hopeful thoughts, going
    to community gatherings, religious services
    instills sense family being supportive
  • Find out what school counseling is in place

  • Reluctant to ask for help
  • Need to provide verbal assurance and attention
  • Loss of independence, not enough time in their
    lives to rebuild or recreate
  • Recovery of possessions, make home visits,
    arrange for companions, provide transportation
  • Relocation to familiar surroundings
  • Re-establish family and social contacts
  • Reduce barriers to accessing resources
  • Assist in obtaining medical, financial assistance
  • Re-establish medication regimens

People with Serious Mental Illness
  • Disruption of medications, treatment, routine
  • May not adapt well to unfamiliar and
    over-stimulating environment of shelters
  • Need monitoring of case management teams
  • Involve family/friends to help with treatment
  • Dont typically experience long-term problems

People with Physical Disabilities
  • Feel vulnerable because of ongoing physical
  • Perceptions of lost control and autonomy
  • Disruption in normal patterns of care or
    assistance leading to anxiety/stress
  • Vulnerable to marginalization, isolation

Culture Counts!
  • Cross-cultural differences related to ethnic,
    religious identity or place of origin
  • Variations in meaning
  • Expression of thoughts, feelings, behaviors
  • Cross-cultural differences may influence
  • Validity of assessment
  • Response to treatment
  • Ways of interacting with survivor
  • Response sensitive to local customs culture
  • Use culturally competent assessments and

Cultural Competence Checklist
  • Meanings associated with current disaster and
    emergency response
  • Beliefs and practices regarding death, burial,
    mourning, trauma and healing
  • Trauma and violence in country of origin/USA
  • Views about mental health and responders
  • Cultural courtesy (who to talk to first, who is
    considered family)

Who is at Risk and Why?
Disasters Communities
  • Disasters and major critical events test
    functioning of communities
  • Affect those directly/indirectly impacted and
    those who come to help
  • Lives, culture, beliefs may be altered and new
    coping skills required
  • Multiple losses related to incident
  • Think of concentric circles to see broad range of
    persons involved in disasters

Continuities of Life Disrupted
  • Conducting normal life disrupted by disaster
  • Functional continuity
  • How to maintain usual routines, roles
  • Historical continuity
  • Lost home, community, place of work, personal
    objects/memorabilia loss of ID, sense of
  • Interpersonal continuity/social network
  • Relocation, loss of home/neighborhood
  • Spiritual continuity
  • Loss of faith, feeling vulnerably, unable to deal
    with a world no longer good, safe or predictable

? Risk of Mental Health Problems
  • Severe exposure to disaster
  • Injury, threat to life, extreme loss
  • Living in highly disrupted/traumatized community
  • Female gender, middle years 40-60
  • Presence of spouse who is highly distressed
  • Membership of ethnic minority group
  • Poverty, low socio-economic status
  • Presence of children in home
  • Psychiatric history
  • Secondary stressors
  • Weak or diminishing psycho-social resources

Pre-Trauma Event
  • Recognize both capacity for vulnerability and
  • ID vulnerable populations with inherent or
  • pre-existing characteristics
  • Fragile/prone to anxiety/depressions
  • Elderly, disabled, refugees, severe mentally ill
  • AODA, socially/economically disadvantaged,
  • Family instability, prior history for trauma,
    parent pathology, middle-age women, children

During Trauma Event
  • Disaster experience greatest exposure leads to
    greatest suffering dose-response relationship
  • Bereavement/loss, injury may predict more
    negative outcome
  • Dissociation/panic may predict worse outcome
  • Relocation, displacement, separation are
    especially difficult for youth and elderly

Post-Trauma Event
  • Positive social support protective factor
  • Belief they are cared for by others
  • Negative or losing social support risk factor
  • Criticism, blame, impatience, second guessing
  • Additional or secondary life stressors
  • Coping belief in ones ability to cope more
    important than specific coping mechanism
  • Avoidance, extreme denial, blaming are
    detrimental ways of coping

Early Interventions Psychological First
Aid Psycho-education Coping Skills
Psychological First Aid (PFA)
  • Used during earliest stage post-event when
    survivors need help taking in information or
    seeing beyond immediate needs
  • Non-intrusive way of being present for victims
  • Meets basic needs first, restoring sense of
    safety, providing comfort and support
  • Targets any acute stress reactions and immediate
    needs to help recovery take place
  • PFA is not about having victims speak about
    traumatic experience, but willingness to listen
    to those who choose to share

PFA Approach
  • Empower survivors by acknowledging and supporting
    strength, competence and courage
  • Let survivors determine kind of assistance they
    receive and the pace of self-disclosure
  • Listen to shared stories which help create order,
    management and meaning, without leaving them with
    unmanageable feelings
  • Help survivors recognize own strengths by asking
    about past coping, skills they have used
    successfully in past
  • Encourage survivors to support and assist others
  • Give children active role caring for self/sibs

PFA Practice Points
  • Be calm and grounded
  • Know your limits
  • Physically available and emotionally present
  • Normalize by providing acknowledgment and
    recognition of suffering and strength
  • Express empathy enter into their world, bear
    witness, communicate understanding/respect
  • Support choice not to self-disclose
  • Dont assume all people need or want more
    help/interventions in the immediate aftermath
  • PFA is based on belief that most people will
    recover naturally on their own

Create Sense of Safety Security
  • Physical security
  • Give directions of what to do, where to go
  • Food, clothing, shelter
  • Emotional safety from media, onlookers
  • Establish personal space to preserve privacy
  • Provide human contact and support
  • Provide safe place to express emotions
  • Assist in contacting reuniting with supports
  • Help children understand what has happened
  • Facilitate problem solving by starting small
  • Provide sense of future and hope

Ventilation and Validation
  • Survivors may want to
  • Tell their disaster story
  • Ventilate feelings and reactions
  • Be heard and feel validated
  • MHRT can help with storytelling process
  • Ask questions to facilitate flow of story telling
  • Echo key words or phrases to acknowledge
  • Support and honor silence by waiting for survivor
    to decide if wants to continue story
  • Listen and summarize to help survivors develop
    narrative for event and to find words to describe
    their reactions
  • Reassure reactions are acceptable and not uncommon

Prediction and Preparation
  • Help in predicting and preparing for
    post-disaster possibilities/challenges
  • Set small, doable goals
  • Focus on daily planning using simple problem
    solving techniques
  • Talk or write about event to bring order to
    chaotic feelings
  • Plan time for memories and memorials
  • Find someone in community to support them
  • Educate survivors about stress reactions that
    might occur for them or children

Is PFA Effective?
  • Continues to be a lack of evidence regarding
    effective early interventions
  • Appears promising and probably is effective
  • Less specific intervention geared to be broader,
    flexible, which uses empathy and collaboration
  • Allows mental health to be visible and helpful
    during early phase after disaster
  • Helps to establish rapport without intruding by
    supporting the natural recovery process
  • May lay groundwork for more intensive
    interventions during recovery phase

PFA as Pre-Screening Tool
  • May serve as a prescreening tool by
  • Knowing who and where are vulnerable populations
  • Targeting resources for them
  • May help to determine best time for intervention
    so not too soon or too late
  • May help survivors accept possible referral for
    follow up treatment if needed

  • Least controversial/most accepted, recommended
  • Info on typical reactions/symptoms experienced
    by survivors resilience effective/ineffective
    coping strategies loss/grief ways for parents
    to help children treatment resources
  • Doing outreach, using media, flyers, websites,
    established community structures like churches,
    schools, community centers
  • Goal to let survivors know what they might
    experience without alarming them or causing them
    to anticipate future distress

  • Normalize/validate reactions to stress
  • Recognize some will have extreme reactions and
    some will have no reactions
  • Avoid using heavy-handed prediction of symptoms
    or stages
  • Suggest reactions typically go away in time
  • Encourages past positive coping strategies
  • Offer stress-reducing strategies social support,
    emotional sharing, exercise, journaling,
    relaxation/meditation, spiritual practices

Coping Strategies
  • Behavioral/problem-focused coping
  • Used in situations that are changeable
  • Actions taken in response to problem
  • Involves info-gathering, problem solving,
    decision-making and direct action
  • Emotion-focused coping
  • Used in situations that are unchangeable
  • Regulates emotional distress aroused by problem
  • Involves compromise, acceptance, distortion/
  • Used to alter meaning of situation
  • Need combination of skills in both areas

Model and Teach Coping Skills
  • Active/problem-focused coping doing something
    about situational, concrete problems
  • Make action plan and take direct action
  • Work on keeping focused/not distracted
  • Seek support/assistance
  • Emotional coping best used when problem does not
    allow for any intervention
  • Not thinking about problem using avoidance,
    denial, or distraction
  • Accepting problem using patience, meditation,
    mindfulness, or prayer
  • Expressing feelings through emotional venting,
    talking, journaling, drawing, singing, movement

Positive Coping Negative Coping
  • Talk to others for support
  • Adequate rest
  • Distracting/pleasant activities
  • Spend time with others
  • Exercise (moderation)
  • Use support groups
  • Seek counseling
  • Alcohol/drugs to cope
  • Isolation/withdrawal
  • Passive coping style
  • Extreme avoidance of thinking, talking about
  • Workaholism
  • Anger/violence

Cognitive Coping Cognitive Reframing Cognitive
Self-Doubt and Self-Blame
  • Common reactions of survivors of disasters or
    traumatic events
  • Unhelpful/hurtful reactions vs. understand they
    did the best they could given circumstances
  • Cognitive distortions or problematic thinking
    styles usually not accurate and causes distress
  • Cognitive coping IDs strongest inaccurate
    thought, challenges and changes thought

Cognitive Reframing
  • Victims get stuck in negative thinking about
    distressful events
  • Putting event, thought, feeling in different or
    new context/ frame creates a different way to
    think or view it
  • Thinking about it in a different way often brings
    up emotionally or factually new information may
    change way you view incident
  • Helps survivor move away from negative pattern of
    thinking and towards a more realistic and
    hopefully positive way of thinking

Informal Cognitive Re-Structuring
  • Strategy used in cognitive coping and is
    informally used in early disaster interventions
  • Cognitive restructuring is learning to disprove
    inaccurate/unhelpful thoughts or ideas/faulty
    thinking and replacing them with more accurate
    and beneficial ones
  • Use care not to correct valid cognitions
  • Goal is to change problematic feelings and
    behaviors by putting thoughts in more realistic
    and balanced perspective

Next Steps
Assess, Identify and Refer
  • Assessment
  • Triage who needs help first and most
  • Target Acute Stress Disorder, traumatic grief,
    other symptoms from prolonged and intense
    exposure to trauma or pre-existing disorders
  • ID/treat those at risk for developing symptoms,
    but havent shown signs or…
  • Refer only when symptoms are not subsiding
    naturally on their own

Stepped Care
  • Most people respond to early interventions
    provided at disasters or major trauma events
  • Some victims may need higher level of care
  • Stepped care concept used in disaster response
    which identifies victims whose needs may be
    beyond scope of what is available in the field or
    at disaster site
  • Stepped care is the process of stepping up to
    next level of care via transport or referral

Referrals for Treatment
  • Occur when person is unable to
  • Perform daily functions, care for personal needs
  • Apply for necessary assistance
  • Make simple decisions
  • Flat affect, unable to act, serious withdrawal
  • Preoccupied, obsessive thinking, compulsions
  • Dissociation or severe reactions to triggers
  • Excessive flashbacks, nightmares
  • Substance abuse/withdrawal
  • Symptoms of psychosis
  • Suicidal or violent behaviors

Follow up Care
  • Where and how to make referral for follow up care
  • Individuals, families, groups
  • Medications
  • Spiritual support
  • Hospitalization
  • Know local resources and community culture
  • Help lines for domestic violence, child respite,
    crime victim services, special needs, burial
    assistance, elderly, interpreters/translators

Tips to ? Accepting Help
  • Often most affected refuse to accept help
    indicative of weakness
  • Fear stigmatization from family, community,
    coworkers if not recovering quickly
  • Use direct/matter-of-fact approach discussing
    available mental health services, normalizing how
    many are helped
  • If parent of child is reluctant, offering
    treatment to help family may be more acceptable
  • Encouraging self-care for parents and their
    families provides permission to seek help

Community Outreach
  • Outreach valuable tool for reaching special
    populations or at-risk survivors
  • Initiating contact at gathering sites
  • Reaching out via media, internet, crisis lines
  • Participating in conducting meetings for
    pre-existing groups like faith-based orgs,
    schools, employers, community centers
  • Providing psycho-ed resources and referral info
    to health-care clinics, human services, police,
    fire/EMS, local county government

ID Key Post-Disaster Events
  • Identify events with potential mental health
  • Examples death notifications, ending rescue and
    recovery operations, criminal justice
    proceedings, returning to scene/impact area,
    memorials/funerals, cultural rituals/honoring
    ceremonies, community gatherings
  • Determine mental health roles
  • Implement mental health interventions

Final Points to Remember…
  • Assist individuals in coping with extraordinary
    stress of disaster/trauma
  • Dont pressure survivors to disclose details
  • Listen to what survivor wants to discuss
  • Dont pathologize reactions, make formal
    diagnoses, use mental health labels or jargon
  • Provide short-term interventions to individuals
    groups experiencing psychological reactions
  • While early interventions are not formal mental
    health treatment, they are an essential component
    of mass disaster response