CERT Disaster Psychology CERT Disaster Psychology Unit 7 Spring 2018 2018-03-26 Disaster Psychology CERT Disaster Psychology Unit 7 Spring 2018

CERT Goal is: Do the Greatest Good for the Greatest Number of People! CERT RULES Personal safety is ALWAYS the number one priority Work as a team Wear personal protective equipment…gloves, helmet, goggles, N95 mask and boots CERT Goal is: Do the Greatest Good for the Greatest Number of People! Hope for the best but plan for the worst

CERT Disaster Psychology 2018-03-26 Unit Objectives Describe the disaster and post-disaster emotional environment for victims and rescuers Describe the steps rescuers can take to relieve their own stress and that of disaster coworkers and survivors FEMA 7-1 w/ “Learn basic short-term” bullets added. Source for extra bullets? Learn basic short-term Psychological first-aid Field-expedient techniques Emotional Intervention

Learn to Prepare Mentally for Disaster Response CERT Disaster Psychology 2018-03-26 Learn to Prepare Mentally for Disaster Response Actions can be taken before, during, and after an incident to help manage emotional impact of disaster response work Knowing possible psychological and physiological symptoms of disaster trauma helps manage impact Learn to manage stress CERT members for themselves CERT leaders during response FEMA 7-6.

CERT Disaster Psychology 2018-03-26 Unit Topics Disaster Trauma Team Well-Being Working with Survivors’ Trauma FEMA 7-2.

WHAT IS DISASTER TRAUMA? CERT Disaster Psychology 2018-03-26 WHAT IS DISASTER TRAUMA? Trauma & stress reactions in disaster Traumatic crisis Vicarious trauma Extreme Impact on Rescuers Sources of Personal Trauma At-Risk Groups Symptoms of Trauma SOURCE – not FEMA nor Lamorinda CERT? Is this just an overview/intro slide?

WHAT IS DISASTER TRAUMA? CERT Disaster Psychology 2018-03-26 WHAT IS DISASTER TRAUMA? Traumatic Crisis An event in which people experience or witness: Actual or potential death Serious injury Actual or threatened sexual violence Destruction of homes, neighborhood, or valued possessions Loss of contact with family / close relationships FEMA 7-12 w/ “sexual violence” bullet added.

WHAT IS DISASTER TRAUMA? CERT Disaster Psychology 2018-03-26 WHAT IS DISASTER TRAUMA? Traumatic stress may affect: Cognitive functioning--Thinking Physical health--Behaving Interpersonal reactions--Feelings FEMA 7-13.

WHAT IS DISASTER TRAUMA? CERT Disaster Psychology 2018-03-26 WHAT IS DISASTER TRAUMA? Vicarious Trauma The process of changes in the rescuer resulting from Empathic engagement with survivors Natural reaction to bearing witness to another’s trauma Identifying too strongly with survivor trauma Modified version of CART slide. CART = Contra Costa County Animal Response Team.

WHAT IS DISASTER TRAUMA? CERT Disaster Psychology 2018-03-26 WHAT IS DISASTER TRAUMA? Rescuers & Volunteers Veterans of recent conflict & wars —OIF/OND/OEF more susceptible People with previous psychological difficulties Lower social support system Post Traumatic Stress Disorder (PTSD) & Depression EXCEPT older people than younger Lower educational achievement Presence of chronic pain (PTSD) or depression, increased alcohol & drug Modified version of Lamorinda CERT slide.

WHAT IS DISASTER TRAUMA? CERT Disaster Psychology 2018-03-26 WHAT IS DISASTER TRAUMA? Rescuers and Volunteers have potentially higher risk for psychological trauma due to Your own personal losses Working in your home neighborhood Assisting neighbors, friends, co-workers who have also been injured Not feeling safe and secure FEMA 7-3

WHAT IS DISASTER TRAUMA? CERT Disaster Psychology 2018-03-26 WHAT IS DISASTER TRAUMA? Possible Psychological Symptoms: Irritability, anger Self-blame, blaming others Isolation, withdrawal Fear of recurrence Feeling stunned, numb, or overwhelmed Feeling helpless Mood swings Sadness, depression, grief Denial Concentration, memory problems Relationship conflicts / marital discord FEMA 7-4 w/ “Suicidal …” bullet added. What is source for new bullet?

TEAM WELL-BEING TOPICS CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING TOPICS Volunteer Self-Care Prevention/Mitigation Team Leader Strategies for Team Care Intro/overview slide

TEAM WELL-BEING .. Self-Care CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING .. Self-Care Be aware that disaster worker trauma/stress can follow disaster work Explain to family member and friends how they can support you Listen to you when you need to talk Understand that you may not want to talk Ask for and accept help from others Seek professional Mental Health support as needed FEMA 7-8 w/ last 2 bullets added.

TEAM WELL-BEING .. Self-Care CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING .. Self-Care Take Care of Yourself Be aware that disaster-worker trauma/stress can follow disaster work Explain to family member and friends how they can support you Listen to you when you need to talk Understand that you may not want to talk Ask for and accept help from others Seek professional Mental Health support as needed Is this FEMA slide? Seems familiar.

CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING Possible Physiological Symptoms Loss of appetite Headaches, chest pain Diarrhea, stomach pain, nausea Hyperactivity Increase in alcohol or drug consumption Chronic Insomnia: Inability to sleep, Nightmares Fatigue, low energy FEMA 7-45 w/ “& Hyper-reactivity“ added. What is source for addition? What does it mean?

CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING Rescuer Safety and Stability First! Attend To Your CERT Team Volunteers SOURCE – not FEMA nor Lamorinda CERT?

CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING First, have your house in order Take care of your basic needs Check on family, pets, neighbors Put on your own Oxygen mask first Then you can help others in distress SOURCE – not FEMA nor Lamorinda CERT?

TEAM WELL-BEING .. Reducing Stress CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING .. Reducing Stress Drink plenty of water Get enough sleep Exercise Eat a balanced diet Balance work, play, and rest Accept that you cannot save everyone Do not over-identify with survivors and do not take their feelings as your own. FEMA 7-7 w/ last 2 bullets added

TEAM WELL-BEING .. Reducing Stress CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING .. Reducing Stress Remember that your identity is broader than just a helper Connect with others for social support Allow yourself to receive as well as give Accept change - Nature and even human nature is not in your control Talk to someone about your feelings. Use spiritual resources FEMA 7-7 w/ bullets1, 4, & 5 added. Leena St Michael or Mary England are sources.

CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING CERT team leaders, and available professionals should: Provide pre-disaster stress management training Brief personnel before deployment Emphasize teamwork – identify Team roles Take breaks away – Team Leads watch for reactions Provide for proper nutrition & hydration Rotate Team members and duties Phase out disaster service workers gradually Conduct a Team debrief discussion FEMA 7-9.

CERT Disaster Psychology 2018-03-26 TEAM WELL-BEING Critical Incident Stress Debriefing phases: 1. Introductions and description 2. Review of factual material 3. Sharing of initial thoughts and feelings 4. Sharing of emotional reactions to incident 5. Instruction about normal stress reactions 6. Review of symptoms 7. Closing and further needs assessment FEMA 7-10. Unknown source for following note - It consists of interviews that are meant to allow individuals to directly confront the event and share their feelings with the counselor and to help structure their memories of the event. However, research has revealed that psychological debriefing does not help trauma survivors, and it might even hurt them.[95] Although from the outset, early psychological debriefing research yielded mixed results, some initial research suggested that psychological debriefings helped ameliorate peritraumatic symptoms and prevent post-traumatic symptom development.[77] But as research progressed, several meta-analyses made it clear that psychological debriefing is unhelpful and potentially harmful.[103][104] The first Cochrane meta-analysis concerned single-session debriefing. More recently a Cochrane review on multiple session interventions was conducted and also found negative results.[105] The American Psychological Association judges the status of psychological debriefing as No Research Support/Treatment is Potentially

WORKING WITH DISASTER SURVIVORS’ TRAUMA

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA Phases of a Crisis Impact – survivors may show no emotion Inventory – survivors assess damage and try to locate other survivors Rescue – survivors willing to cooperate with rescuers Recovery – survivors may pull together against rescuers & show hostility toward rescuers Expect survivors to show psychological effects – some of it may be directed at you! FEMA 7-11.

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA Mediating Factors for Survivors’ Reactions Prior experience with similar event may lead to cumulative emotion and greater stress reactions Intensity of disruption from disaster: the more disruption, the greater the psychological and physiological reactions may become Individual feelings about event, such as perceived meaning of event Emotional strength of individual Length of time since event FEMA 7-14. RESCUERS MUST NOT TAKE SURVIVORS’ SURFACE ATTITUDES PERSONALLY

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA How to Help Listen: talking about feelings is often needed for processing them Show that you hear their concerns: they want to know that someone else shares their feelings of pain and grief Break isolation: connect to natural support systems such as family, friends, or clergy SOURCE – not FEMA nor Lamorinda CERT?

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA FIRST, Physical First Aid – Stabilize Victims Triage survivors: RPM’s for Airway, Bleeding, Shock Get uninjured people involved in helping THEN, Psychological Support – when time/resources are available – Provide support by: Listening Empathizing, Paraphrasing Help survivors connect with social support systems Professional Follow-up Mental Health Referrals FEMA 7-15 – modified.

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA How to Be an Empathetic Listener Put yourself in the speaker’s shoes Listen for meaning, not just words Pay attention to body language - nonverbal communication Reflect (paraphrase) the speaker in their own words to show that you heard him/her. FEMA 7-16.

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA How to Be an Empathetic Listener Allow silence – silence gives survivor time to reflect and become aware of feelings. Silence can prompt the survivor to elaborate. Attend nonverbally – eye contact, head nodding, caring facial expressions, and occasional “uh-huhs”. Paraphrase – when you repeat portions of what the survivor has said, understanding, interest, and empathy are conveyed. Reflect feelings – the survivor’s tone of voice or nonverbal gestures may suggest anger, sadness, or fear. Possible responses are “You sound angry, scared, etc. Does that fit for you?” This helps survivor identify and articulate their emotions. Allow expressions of emotion – expressing intense emotions through tears or angry venting is an important part of healing; it often helps survivor work through feelings so they can better engage in constructive problem-solving. From CART, CART = Contra Costa County Animal Response Team.

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA What You Can Say . . . “These are expected reactions to a disaster.” “It is understandable you could feel this way.” “You can’t change what happened but you can change what you do with this experience.” “Things may never be the same, but you may find some things from this experience that can help you help others.” Apologize if survivor reacts negatively to something that you say Not FEMA nor Lamorinda CERT. Likely source Leena St Michael or Mary England.

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA Avoid Saying . . . “I understand.” “Don’t feel bad.” “You are strong” or “You’ll get through this.” “Don’t cry.” “It’s God’s will.” “It could be worse” or “At least you still have . . . What you really must do… (Discounts person, not understood, more alone) FEMA 7-17.

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA Managing the Death Scene Cover the body; treat it with respect Move the body to temporary morgue (if death occurs at Command Post) Follow local laws and protocols Talk with local authorities FEMA 7-18

WORKING WITH DISASTER SURVIVORS’ TRAUMA CERT Disaster Psychology 2018-03-26 WORKING WITH DISASTER SURVIVORS’ TRAUMA Informing Family of a Death Separate the family members/friends from others in a quiet, private place Have the person(s) sit down, if possible Make eye contact and use a calm, kind voice Use the following words to tell the family members about the death: “I’m sorry, but your family member has died. I am so sorry.” Have one family member look at the body and decide if the rest of the family should see the body Allow family members to hold or spend time with the deceased Let the family grieve privately if possible FEMA 7-19

UNIT SUMMARY Rescues may be unpleasant or uncomfortable Psychological and physiological symptoms of trauma Take steps to reduce stress CISD is one intervention Four emotional phases of a disaster Stress affects cognition, health, and interactions Stabilize individuals Be an empathetic listener

EXERCISE: DISASTER PSYCHOLOGY CERT Disaster Psychology 2018-03-26 EXERCISE: DISASTER PSYCHOLOGY Team Up Review Scenarios of: Children, Elderly, Acutely Stressed Adult How would you Respond in the Scenario? Not FEMA nor Lamorinda CERT. Likely source Leena St Michael or Mary England.

DISASTER PSYCHOLOGY UNIT # 7 RESOURCES CERT Disaster Psychology 2018-03-26 DISASTER PSYCHOLOGY UNIT # 7 RESOURCES Unit # 7 Participant Manual Unit # 7 Video <http://1.usa.gov/1pra6dE> Unit # 7 Video transcript <http://1.usa.gov/1pra6dE> Unit #7 slide handout NERT Psychological First Aid handouts Addendum Worksheets NERT handouts are publicly available on the Internet and not marked as copyright.

HOMEWORK for Class 2 Fill out the NERT Psychological First Aid handout. Think about how you will feel and respond to a disaster, to CERT coworkers, and to victims. Watch FEMA/CERT video online: Unit # 7 Video <http://1.usa.gov/1pra6dE> Unit # 7 Video transcript <http://1.usa.gov/1pra6dE>