Crisis Counseling Assistance and Training Program Regular Services Program Midprogram Training

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Crisis Counseling Assistance and Training
ProgramRegular Services ProgramMidprogram
Training
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Objectives

• After training, participants will be able to
• Identify the continued needs of survivors, the
  community, and staff.
• Revise outreach strategies.
• Review effective crisis counseling skills.
• Recognize program successes and challenges.
• Apply techniques for managing staff stress.
• Identify effective approaches to program
  management, legacy, and phasedown.

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Table of Contents

• Section 1Individual, Community, and Staff
  Needs
• Section 2Program Assessment
• Section 3Crisis Counseling
• Section 4Program Management
• Section 5Stress Management

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Section 1Individual, Community, and Staff Needs

• Current and Upcoming Phases of the Disaster
• Needs of Individual Survivors
• Needs of the Community
• Needs of Crisis Counseling Staff

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Current and Upcoming Phases of the Disaster
Collective reactions
Adapted from CMHS, 2000.
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Current and Upcoming Phases of the Disaster
(cont.)

• Disillusionment phase
• Stress and fatigue take a toll
• Optimism turns into discouragement
• There may be an increased need for substance
  abuse services
• The larger community returns to business as
  usual and
• The CCP may have an increased demand for
  services, as individuals and communities become
  ready to accept support.
• Reconstruction phase
• Individuals and communities begin to assume
  responsibility for rebuilding their lives
• People begin to adjust to new circumstances and
• There is a recognition of growth and opportunity.

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Needs of Individual Survivors

• Questions
• Whom has the program served?
• What is the status of the survivors who have
  received services?
• What survivors still need to be reached?
• What services are still needed?
• What other community or individual supports can
  meet these needs?

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Needs of the Community

• Questions
• What communities has the CCP served?
• What is the status of community recovery?
• What populations still need to be targeted?
• Who are the community gatekeepers and cultural
  brokers?
• What community organizations have been contacted?
• What resources still need to be identified?
• What still needs to be accomplished in the
  community?

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Needs of Crisis Counseling Staff

• What will help staff members address identified
  individual and community needs?

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Section 2Program Assessment

• Program Successes
• Program Challenges

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Program Successes

• What are some successful outreach and engagement
  strategies?
• What interventions and crisis counseling
  techniques have worked well?
• What are some tangible resources developed by the
  program?
• What are some successful community approaches?
• What are other program successes?

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Program Challenges

• What are some ongoing programmatic challenges
  related to each of the following
• Survivors
• Community and
• Staff.
• Does the program have the tangible resources it
  needs? If not, what else is needed?

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Section 3Crisis Counseling

• Crisis Counseling Services at Midprogram
• Crisis Counseling Skills
• Ethical Considerations

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Crisis Counseling Services at Midprogram
CCP reach of services
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Crisis Counseling Services at Midprogram (cont.)

• Traditional treatment vs. crisis counseling

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Crisis Counseling Services at Midprogram (cont.)

• Midprogram is a time to
• Increase focus on group crisis counseling
  services, community support and networking, and
  public education.
• Strengthen crisis counseling skills.
• Facilitate referral of individuals to existing
  long-term community resources.

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Crisis Counseling Services at Midprogram (cont.)

• Group crisis counseling is characterized by
• Services that help group members understand their
  current situation and reactions to the disaster.
• A need that may increase later in the CCP as
  people are ready to connect with others.
• Group members who should have had similar levels
  of exposure.
• Participants gaining mutual support from other
  group members.
• Psycho-education areas that include stress
  management, coping with triggers, expressing
  emotions, and problem solving.

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Crisis Counseling Services at Midprogram (cont.)

• Support groups
• Are less structured than psychotherapy groups.
• Increase the social support network.
• Facilitate exchange of information on life
  situations.
• Help develop new ways of adapting and coping.
• Can be member facilitated.

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Crisis Counseling Services at Midprogram (cont.)

• Self-help groups
• Are appropriately facilitated by a professional
  or paraprofessional crisis counselor.
• Can be cofacilitated by a group member to
  encourage transition to a member-facilitated
  process.
• Once the group has transitioned to a
  member-facilitated process, it is no longer a CCP
  service.

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Crisis Counseling Services at Midprogram (cont.)

• Psycho-educational groups
• Provide tools to obtain and process new
  information.
• Usually have limited duration and scope.
• Provide practical and concrete assistance.
• Use handouts and factual information relevant to
  the groups discussion.
• Use speakers relevant to the content area and
  group members needs.

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Crisis Counseling Services at Midprogram (cont.)

• Group crisis counseling ethical considerations
• Assess your own knowledge and skills related to
  the content of the group.
• Be aware of your own values, biases, and beliefs,
  and how these affect the group.
• Respect and maintain confidentiality.
• Facilitatedo not dominatethe conversation.
• Ask for feedback.
• Rappin Kell, 1998.

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Crisis Counseling Services at Midprogram (cont.)

• Public education
• Can be educational presentations and materials,
  or one-on-one or group education.
• Are likely to increase throughout the course of
  the CCP.
• Are designed to
• Build resilience
• Promote constructive coping skills
• Educate about disaster reactions
• Help people access support and services and
• Leave a legacy of educational materials.

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Crisis Counseling Services at Midprogram (cont.)

• Assess and refer in relation to the following
  behavioral health risk factors and reactions
• Safety.
• Level of exposure to the traumatic event.
• Prior trauma or physical or behavioral health
  concerns.
• Presence of severe reactions.
• Current level of functioning.
• Alcohol and drug use.

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Crisis Counseling Services at Midprogram (cont.)

• Adult Assessment and Referral Tool

• Used to facilitate referrals to more intensive
  behavioral health services.
• First used during a third individual crisis
  counseling encounter.
• Measures risk categories and event reactions
  using a structured interview approach.
• If a person scores three or more intense
  reactions (ones scored 4 or 5), then referral for
  more intensive services should be discussed.

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Crisis Counseling Services at Midprogram (cont.)

• Emergency treatment referral
• Alert the team leader if
• There is intent or means to harm self or others
• Person experiences severe paranoia, delusions, or
  hallucinations
• Functioning is so poor that persons (or
  dependents) safety is in danger and
• Excessive substance use is placing person or
  others at risk.
• When in doubt, call 911, or refer for immediate
  psychiatric or medical intervention.

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Crisis Counseling Services at Midprogram (cont.)

• Nonemergency treatment referral
• Reduce perceived stigma
• Demystify mental health or substance abuse
  treatment by explaining it and
• Explore referral options, and give choices.
• Increase compliance
• Explore obstacles to accepting services
• Encourage person to call for the appointment
  while the counselor is there and
• Accompany person to first appointment, if
  necessary and appropriate.

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Crisis Counseling Services at Mid-Program
(cont.)CCP resource linkage
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Crisis Counseling Skills

• What do we want to accomplish during crisis
  counseling?
• Assist survivors to
• Identify and prioritize needs
• Identify previous and current constructive coping
  strategies
• Develop a plan to enhance coping strategies and
  skills.

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Crisis Counseling Skills (cont.)

• The CCP model facilitates resource linkage
  through
• Role modeling.
• Reinforcing.
• Empowering.

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Ethical Considerations

• Maintain confidentiality.
• Follow State and local reporting regulations in
  cases of suicidal or homicidal intent.
• Follow the State and local regulations on
  mandatory reporting for child or elder abuse and
  neglect.
• Safeguard interests and rights of individuals who
  lack decisionmaking abilities.
• Treat all individuals in a nonbiased manner with
  regard to race, ethnicity, gender, religion,
  sexual orientation, and age.

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Ethical Considerations (cont.)

• Do no harm.
• Participation is voluntary.
• Consider reactions in relation to the disaster
  phase and context.
• Individual coping styles should be respected.
• Immediate interventions are supportive.
• Talking with a person in crisis does not always
  mean talking about the crisis.
• Be aware of the situational and cultural contexts
  of the survivor and the intervention itself.

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Section 4Program Management

• Revising Program Strategies
• Quality Assurance
• Data Collection and Evaluation
• Supervision
• Training
• Preparing for Phasedown

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Revising Program Strategies

• How will the program continue to deliver CCP
  services to meet identified individual and
  community needs?
• How will the CCP overcome the identified
  programmatic challenges?
• How will the CCP begin to prepare for eventual
  phasedown?

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Quality Assurance

• Ensures staff follow the CCP model through
• Regular onsite supervision and training.
• Consistent communication among CCP management and
  workers.
• Weekly meetings and submission and review of data
  collection forms.
• Collection and organization of program materials
  and data.
• Identifying problems and gaps in service.
• Redirecting resources and modifying the service
  plan to close gaps.
• Ongoing needs assessment.

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Data Collection and Evaluation

• Data collection and program evaluation are
  systematic efforts to collect, analyze, and
  interpret information.
• We do it to understand and improve services based
  on observable and verifiable data.

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Supervision

• Conduct group meetings to discuss staff needs.
• Conduct regularly scheduled individual
  supervision sessions.
• Ensure availability of needed supplies and
  equipment.
• Provide ongoing training opportunities on
  CCP-specific topics.

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Training

• Standard CCP trainings

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Preparing for Phasedown

• Assess the need.
• Identify community capacity.
• Identify untapped supports.
• Begin creating a phasedown plan.

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Preparing for Phasedown (cont.)

• The CCP supports, but does not replace, community
  infrastructure.
• Transitioning needs and services back to
  communities is a key part of the CCP model.
• The phasedown process helps communities take
  responsibility for individual survivor and
  community needs.
• Active community involvement in the transitioning
  of services is an important sign of recovery.

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Preparing for Phasedown (cont.)

• Midprogram assessment and revised outreach
• Review program data, and analyze provider
  activity to assist in the decision about when to
  begin the formal phasedown.
• Be open to an early phasedown if there is a
  greatly reduced need.
• Adjust outreach and service-delivery approach by
  decreasing outreach over time.
• Shift community activities to phasedown messaging
  rather than seeking new referrals.

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Section 5Stress Management

• Typical Stressors
• Warning Signs of Excessive Stress
• Organizational Approaches to Stress Management
• Individual Approaches to Stress Management

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Typical Stressors

• How stressful are these for you?
• Repeatedly hearing survivors distressing
  stories.
• Approaching survivors who may reject help.
• Feeling overwhelmed by others sadness.
• Feeling helpless to alleviate the pain of others.
• Working long hours.
• Personal experience with the disaster.

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Warning Signs of Excessive Stress

• How do you know when you are experiencing
  excessive stress?
• You cannot shake distressing images from your
  mind.
• Work consumes you at the expense of family and
  friends.
• You experience an increase in substance use or
  abuse.
• You are excessively irritable and impatient.
• You exhibit other serious or severe reactions.

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Organizational Approaches to Stress Management

• Elements of organizational stress management
• A clearly defined management and supervision
  structure.
• Clearly defined purpose and goals that are
  articulated frequently.
• Functionally defined roles that are reinforced
  through effective supervision.
• Sound clinical consultation, support, and
  supervision.
• Supportive peer relationships.

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Organizational Approaches to Stress Management
(cont.)

• Management responsibilities
• Clearly articulate and often repeat the purpose,
  goals, scope, and limits of the program.
• Articulate and enforce policies related to work
  hours, holidays, supervision, and attendance at
  staff meetings and training events.
• Develop criteria for who is served and for how
  long, and require justification for continued
  counseling.
• Enforce safety policies, and enforce ethical
  conduct.

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Organizational Approaches to Stress Management
(cont.)

• Adequately prepare counselors for their tasks
• Use simulation exercises to practice responses to
  highly distraught people.
• Develop a repertoire of introductory statements
  that are free of mental health references.
• Practice how to conclude a counseling
  relationship.
• Provide examples of signals that indicate whether
  talking about problems is bringing relief to the
  consumer employ buddy systems.
• Educate about the differences between helping and
  rescuing.

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Organizational Approaches to Stress Management
(cont.)

• Address disillusionment and other midprogram
  stressors.
• Provide careful supervision.
• Enforce reasonable work hours and shifts.
• Monitor time off, and mandate, if necessary.
• Develop and enforce safety policies.
• Adequately prepare counselors for their work.

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Individual Approaches to Stress Management

• What have you been doing to manage stress?
• Activity
• Update your personal stress management plan.

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SAMHSA Disaster Technical Assistance Center

• SAMHSA DTAC supports SAMHSAs efforts to prepare
  States, Territories, and local entities to
  deliver an effective behavioral health response
  during disasters.
• Toll-Free 1-800-308-3515
• E-Mail dtac_at_esi-dc.com
• Web www.mentalhealth.samhsa.gov/dtac