Crisis Intervention Training for Disaster Workers

An Introduction

George W. Doherty

• Publisher: Modern History Press
• Year: 2007
• Print ISBN: 9781932690422
• eBook ISBN: 9781615999279
• Topic: Psychology
• Subtopic: Psychopathology
• Index: Psychology

This book provides information about training for mental health professionals and first responders who work with victims of disaster related stress and trauma. It helps prepare them to relate with disaster victims and co-workers. Warning signs and symptoms are explored together with stages, strategies and interventions for recovery.

The book will introduce you to disasters, the community response, the roles of first responders, Disaster Mental Health Services and Critical Incident Stress Management (CISM) responders and teams. It provides a brief overview of these and their roles in responding to the needs of both victims and disaster workers. The role of CISM is presented and discussed both for disasters and other critical incidents. This includes discussion about war, terrorism and follow-up responses by mental health professionals. The book is designed to help readers identify appropriate methods for activating Disaster Mental Health Crisis Intervention Teams for disaster mental health services for victims, co-workers, and self.

The content includes general theory and models of Disaster Mental Health, CISM, crisis intervention techniques commonly used in these situations, supportive research, and practice of approaches used in responding to the victims, workers and communities affected by disasters, critical incidents and terrorism threats and events.

What People are Saying About Crisis Intervention Training for Disaster Workers

"Provides a breadth and depth of knowledge as well as practical tools for beginner to expert. Should be required reading for all disaster responders, and, especially, mental health professionals considering disaster work."
-Bruce L. Andrews, MS, LPC (ARC Disaster Mental Provider/Instructor)

"This text serves as a wonderful adjunct and lead into the discipline of CISM. It provides a brief survey of disaster mental health and disaster mental health services."
-Thomas Mitchell, LPC

Rocky Mountain Disaster Mental Health Institute Press
"Learning from the past and planning for the future"

PSY018000 Psychology : Mental Illness
EDU045000 Education : Counseling - Crisis Management
SOC040000 Social Science : Disasters & Disaster Relief

1

Introduction

Working with survivors following the loss of loved ones, homes, property or community is one role of disaster mental health professionals. Besides meeting their basic physical needs, clients will need to understand the grieving process, which may extend for a prolonged period of time. Disaster mental health professionals also work with first responders and other responders to disasters and critical incidents. Their role here is to assist in keeping responders on the job and to help mitigate post-traumatic stress.

Throughout this course, you will learn why Critical Incident Stress Management, Defusing, Debriefing and other forms of crisis intervention have important roles in alleviating disaster induced stress and in preventing further psychological complications among victims and first responders.

Definitions

A crisis is defined in terms of an individual's response to a situation rather than in terms of the situation itself. The same situation may produce a crisis in one person, but not in another. A crisis exists when a person feels so threatened in a situation that he/she cannot cope with it. Their normal resources for dealing with an emergency break down and the individual becomes immobilized. Thus, a crisis exists IN a person. The individual may become confused and overwhelmed by the situation and unable to meet the demands placed upon him/her. It is therefore understandable that a disaster may produce a crisis reaction in an individual, whether they are a survivor or a responder.

A crisis may also be an important learning experience for an individual. Normal patterns of behavior have fallen apart, leaving defenses down. The individual is open and accepting of help in problem solving in order to restore his/her equilibrium. New coping skills and strategies may be developed to assist with this as well as future crises which may occur.

Following are some of the definitions of major techniques which are commonly used by disaster mental health professionals to assist responders and victims who may have experienced a disaster related crisis.

Crisis Intervention: Focuses on providing immediate emotional support (psychological first aid) at times when a person's own resources appear to have failed to adequately cope with a problem.

Critical Incident Stress: The reactions that occur during or immediately after the actual incident, disaster or stressor.

Defusing: An on-scene opportunity for responders involved in a stressful incident to vent their feelings, and institute coping strategies which can reduce stress while they are still working in the assignment setting.

Debriefing: An organized approach to supporting disaster responders who have been involved in emergency operations under conditions of extreme stress in order to assist in mitigating long-term emotional trauma. Usually done at the end of an assignment as part of exiting procedure to assist the responder in putting closure on the experience.

Critical Incident: Any situation faced by emergency responders or survivors that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function, either on the scene or later.

2

Fundamentals

Fundamentals of Victims’ Responses to Disasters

In order to fully understand the necessity for and functions of a Crisis Intervention Team, it is important to have a basic understanding of the psychological factors which influence the emotional responses of disaster victims and responders. This section presents and discusses the basics of those factors and the resulting commonly observed responses of survivors and responders.

Loss, Mourning, and Grief

All survivors of disaster suffer loss. They suffer loss of safety and security, loss of property, loss of community, loss of status, loss of beauty, loss of health, or loss of a loved one. Following a disaster, all individuals begin a natural and normal recovery process through mourning and grief.

In our western culture, we put emphasis on life and youth. We often refuse to think about death. It is normal to be upset by a major loss—and then to suffer because of it. Bereavement is always deeply painful when the connection that has been broken is of any importance. The loss which is the reason for our mourning most often involves a person close to us. However, it can also be a familiar animal, an object to which we are very attached, or a value we have held dear. In mourning, the connection with what we have lost is more important than the nature of the lost object itself.

Grief is the process of working through all the thoughts, memories and emotions associated with that loss, until an acceptance is reached which allows the person to place the event in proper perspective. Theories of stages of grief resolution provide general guidelines about possible sequential steps a person may go through prior to reaching acceptance of the event. These stages include: Denial, Anger, Bargaining, Depression, and Acceptance (see Fig. 2-1). Whereas these theories provide general guidelines, each person must grieve according to his or her own values and time line. However, some persons will have trouble recovering emotionally and may not begin the process of mourning effectively. This may result in troubling and painful emotional side effects. Sometimes these side effects may not appear immediately. They may remain beneath the surface until another crisis brings the emotions out into the open. Hence, many individuals may be surprised by an increase in emotionality around the third month, sixth month, and one year anniversaries of the event. Crisis intervention can assist victims and facilitate their progress in proceeding through the predictable phases of mourning, thus avoiding surprise reactions or emotional paralysis later.

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Fig. 2-1 Stages of Grieving (Kübler-Ross)

Grief is the process of working through all the thoughts, memories, and emotions associated with a loss, until an acceptance is reached that allows the person to place the event into the proper perspective. Some typical reactions to grief might include:

• People who say they are drained of energy, purpose and faith. They feel like they are dead.
• Victims who insist they do not have time to work through the grief with “all the other things that have to be done”, and ignore their grief.
• People who insist they have “recovered” in only a few weeks after the disaster, and who are probably mistaking denial for recovery.
• Victims who focus only on the loss and are unable to take any action toward their own recovery.
• Each of these extreme emotional states is very common, very counterproductive, and requires active crisis intervention.

Stages of Grieving

Denial: At the news of a misfortune, tragedy or disaster, our first reaction is not to accept it, but to refuse it (“No, it's not true! No! It's not possible!”). The opposite would be abnormal. This is a sign that it is essential for our psychological organization to avoid pain without ignoring reality. This refusal is, at the same time, the beginning of an awareness of the horrible reality and is aimed at protecting us from the violence of the shock.

Anger: A feeling of anger is experienced at the fact of our powerlessness in the face of something imposed on us arbitrarily. This anger is inevitable and it must be permitted. It allows the expression of our helplessness at the situation. Therefore, it isn't surprising that survivors (and sometimes responders) take out their anger on the people around them (government and municipal officials, rescue personnel, insurance companies, their families and friends, etc.). Hence, there is the need to be able to verbalize and vent this anger in post-traumatic sessions with a counselor.

Depression: The path toward the acceptance of bereavement passes through the stage of depression. At the beginning of mourning, and for a long time after during this stage of depression, the lost being is omnipresent. Of course, he or she is lost to us in reality we agree and we are trying to accept it. However, inside, we reinforce our connection to him or her, because we no longer have it in objective reality. This process of intense re-appropriation allows us, at the same time, both to lessen our pain and to console ourselves in a way by means of the temporary survival of the loved being within us. At the same time, this movement enables the work of detachment to be carried out little by little.

Generally, slowly over time, these movements of detachment become less frequent, the pain subsides, the sadness lessens, the lost being seems less present and his or her importance tends to decrease. The end of mourning is approaching.

Acceptance: This stage is neither happy nor unhappy. Mourning leaves a scar as does any wound. But the self once again becomes free to live, love and create. One is surprised to find oneself looking toward the future, making plans. It is the end of mourning.

The normal process of mourning takes place over a period of several months.

Returning To Equilibrium

Mental health is described by Antoine Parot as “a psychic ability to function in a harmonious, agreeable, effective manner when circumstances allow, to cope flexibly with difficult situations and to reestablish one's dynamic equilibrium after a test.”

Every time a stressful event happens, there are certain recognized compensating factors which can help promote a return to equilibrium. These include:

• Perception of the event by the individual
• The situational reports which are available
• Mechanisms of adaptation

The presence or absence of such factors will make all the difference in one's return to a state of equilibrium. The strength or weaknes...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents and Course Outline
• Table of Figures
• About the Cover – Medicine Bow Peak
• Goals and Objectives
• Chapter 1 – Introduction
• Chapter 2 – Fundamentals
• Chapter 3 – Children and Disasters
• Chapter 4 – Special Risk Groups
• Chapter 5 – Cultural Aspects of Disasters
• Chapter 6 – Crises in Rural Areas
• Chapter 7 – Crises and Crisis Interventions
• Chapter 8 – Stress Management
• Chapter 9 – Coping and Resiliency
• Chapter 10 – War
• Chapter 11 – Terrorism and Terrorists
• Selected References
• Appendix A – Disaster Scenario
• Appendix B – Disaster Victims’ Needs Assessment
• Appendix C – Course Test
• About the Author
• Index