1. Populations with Special Considerations * Midwestern Regional Training * May 4 – 6 * Chicago, IL

2. Possible Populations with Special Considerations Children Elderly/middle- aged Disaster workers/first responders/ medical staff  Trauma survivors Ethnic/cultural groups/minorities Immigrants & migrant workers Refugees Individuals with disabilities (medical and behavioral)

3. Possible Populations with Special Considerations (cont.) Victims of domestic violence Families of first responders Media Victims who have become disaster workers/first responders/ counselors Clergy/spiritual leaders

4. Training for Work with Special Populations Includes: Competence in listening and communication Assessment that is appropriate to the population Established interventions to reduce distress Full understanding of the context to determine the appropriateness and feasibility of specific interventions.

5. Incorporating Populations with Special Considerations into Disaster Planning Involve key members of each special population within an advisory group or Disaster Planning Consultation Board Identify specific needs as perceived by community members for inclusion into disaster plans. Manson, S. Health Care and Older Ethnic Minorities: A Guide for Integrating Culture and the Clinical Process. Denver University of Colorado Health Service Center for Needs Assessment Study, 1995.

6. Collaboration with Existing Local Resources Local resources may help staff to understand indigenous perceptions of suffering, illness, loss, pain, and healing Collaboration with traditional healers is important Local leaders may help to endorse the program and identify solutions to problems Local leaders may help to build or rebuild social support networks, and act as “cultural brokers”

7. Cultural Sensitivity, Competency, and Diversity in Disaster Behavioral Health Services Sensitivity: Being aware of the various cultural groups affected by the disaster. This includes ethnic and racial groups hardest hit by the disaster, language barriers and attitudes towards “outsiders,” including the government

8. Cultural Sensitivity, Competency, and Diversity in Disaster Behavioral Health Services (cont.) Competency: Being aware of one’s own values, attitudes, and prejudices; being committed to learning about cultural differences; and being creative, flexible, and respectful of others’ values and beliefs in interventions and outreach approaches Diversity: Includes social class, gender, race, ethnicity, and lifestyle.

9. Recommendations for Working with Populations with Special Considerations Utilize culturally competent skills Utilize the population with special considerations as disaster workers/first responders/ medical staff Assess community members and individuals for relevant cultural and traditional mores. Manson, 1995

10. Recommendations for Working with Populations with Special Considerations Learn some of the language, at least the commonly used words. Find a mentor who is known to the community Enlist key members of the community Use a natural setting to collect information – go into the community Manson, 1995

11. Meet with special population members to identify specific needs of the community Learn more about the native healers-or the general way the community uses and accesses health care Recommendations for Working with Populations with Special Considerations Manson, 1995

12. Recommendations for Working with Populations with Special Considerations (cont.) Learn all about the community, strengths and weaknesses Use the communication style of the community Maintain your awareness as you work with a special population. Manson, 1995

13. Values Intrinsic to Working with Populations with Special Considerations Respect the needs, resources, and strengths of the person and community Ensure staff is grounded in knowledge of care appropriate for disasters Recognize the legitimacy of multiple perspectives on trauma and related concerns. Danieli, Y., et al. Guidelines for International Training in Mental Health and Psychosocial Interventions for Trauma Exposed Populations in Clinical and Community Settings. Task Force on International Trauma Training of the International Society for Traumatic Stress Studies, 20k02

14. Values Address cultural issues within the training and management of the program Allow indigenous structures to take a leadership role over time in directing the process; psychosocial interventions may not be effective if not supported by a stable social environment Ensure that personnel are practically and mentally prepared for conditions in the field. Danieli, 2002

15. Values, cont. Keep in mind that every client or victim may be a part of a population with special considerations When appropriate, utilize members of a population with special considerations as examples of resilience Use the population’s resources Be non-conventional Include rather than exclude Danieli, 2002

16. Intervention Strategies Learn local norms from community leaders Use bilingual and bicultural staff Allow time to gain acceptance in a community Be dependable, non –judgmental, respectful. Adapted from CMH Disaster & Crisis Mental Health Populations with Special Considerations presentation.

17. Intervention Strategies, (cont.) Recognize cultural variation in expressions of grief or trauma reactions Recognize varying cultural acceptance of mental health interventions Provide community education information in multiple languages Focus on problem-solving and concrete solutions

18. Populations with Special Considerations  Ethnic/Cultural Groups  Minorities

19. Importance of Cross-Cultural Competency The population of the United states is becoming increasingly diverse In year 2000, 25% of the U.S. population was classified as minority By year 2050, it is predicted that more than 50% of the U.S. population will be from a non-European background U.S. Dept. of Commerce (2001), Current population survey, 1998, 1999, & 2000, Washington, DC: U.S. Government Printing Office

20. Ethnic/Cultural Groups/Minorities Cultural differences lead to different health-seeking behaviors Tendency for more physical complaints as expressions of psychological distress Stigma toward mental health/substance abuse Previous exposure to trauma may worsen coping with current trauma Difficulty navigating benefit system.

21. Factors of Ethnic/Cultural Groups/Minorities Influencing Disaster Response and Recovery Dominant language used within households Family structure Willingness to access services Location of services Adapted from CMHS Disaster & Crisis Mental Health Populations With Special Considerations presentation

22. Basic Principles in Working with Ethnic/Cultural Groups/Minorities Use bilingual and bicultural workers Access to trained interpreters Maintain awareness of immigration experience and status Identify and utilize family values and support systems Be cognizant of cultural values and traditions. Adapted from CMHS Disaster & Crisis Mental Health Populations With Special Considerations presentation

23. Adapted from CMH Disaster & Crisis Mental Health Populations with Special Considerations presentation. Recognize & respect differences Understand cultural definitions of behavioral health, well-being, coping, and recovery Provide services and information in primary languages. Basic Principles in Working with Ethnic/Cultural Groups/Minorities, (cont.)

24. Populations with Special Considerations: Refugees 35 million people forced from their homes by violence & repression 21 million internally displaced Number of countries producing massively uprooted populations doubled 2,000,000 + refuges in U.S. since 1980; 72,515 admitted in FY 2000

25. Populations with Special Considerations Individuals with Disabilities Individuals with mental illness –May worsen preexisting conditions –New trauma may exacerbate existing history of trauma –Loss of social support –Interruption of treatment –Cannot navigate benefit structure Individuals who are homeless –Preexisting problems with social support –Concomitant problems (medical substance abuse, psychiatric). –The most vulnerable are hurt worst in most disasters –Easily overlooked and already marginalized.

26. KEY CONCEPTS TO REMEMBER The target population is normal Avoid behavioral health labels Be innovative in offering help Fit the program into the community Be aware of the cultural differences of each special population. Adapted from CMHS Disaster and Crisis Mental Health Populations with Special Consideration presentation

27. KEY CONCEPTS TO REMEMBER Strategize on how to access your populations with special considerations Invite the “cultural broker” of the community or each population with special considerations to participate in planning Be aware of gaps in intervention and service to populations with special considerations Adapted from CMHS Disaster and Crisis Mental Health Populations with Special Consideration presentation