How you can help during a crisisJuly 2014

Human-Caused Disaster◦ Deliberate; human violence or human error◦ Preventable; sense of betrayal by another person◦ External anger and blame◦ Extended litigation that prolongs recovery

Natural Disaster◦ Beyond human control with no evil intent◦ World can be seen with an increased potential for

random, uncontrolled disasters

Size/Scope of Disaster – as communities are destroyed, survivors become disoriented at the most basic level. If some part of community is left, there is a foundation from which recovery can occur.

Degree of Personal Impact – the higher degree of personal exposure one has, the greater post-disaster reaction

Visible Impact – prolonged impact without a clear end can impede recovery process

Probability of Recurrence – increased probability increases anxiety of being impacted again

Research has indicated that when a disaster occurs, one’s primary focus is for the well-being of family and close friends

Physical◦ Fatigue, headaches, rapid heartbeat, restlessness

Emotional◦ Anxiety, anger, grief, shock, irritability, fear,

detachment, mood swings Mental/Cognitive

◦ Racing thoughts, confusion, lack of concentration, preoccupation with event

Behavioral◦ Pacing, crying, neglecting basic needs, blaming

(self or others)

Reaction of Reality◦ Shock, disbelief, confusion, sleep/appetite

disturbance, fatigue, preoccupied with details of event

Adjustment◦ Assess loss and initiate recovery efforts; may

display mood swings, frustration over lack of control, resentful, and constantly fatigued

Restabilization◦ Remaining problems are overcome and changes

from disaster are accepted

No one who sees a disaster is untouched Most individuals will pull together and function during

and following a disaster but their effectiveness is diminished

Many emotional reactions stem from problems of living caused by the disaster

Most individuals do not see themselves as requiring mental health services

Disaster mental health services tend to be more practical and must be tailored to meet the community

Interventions must be appropriate to the phase of disaster

Support must be genuine

President, NALC Branch 204

Colorado Springs, CO  80917

Colorado Springs, CO

Lower morale Increased

absenteeism Increased anxiety

and anger Lack of

concentration

Increased fear Under work or

overwork Difficulty in creative

problem-solving Possible job

turnover

Optimism

Shock and Denial

Anger

Bargaining

Despair

Pessimism Testing

Sense of Hope

Acceptance

Cautious Optimism

Individual Initiative

Continuous Improvement

Guilt

Event

Phase I – Emergency Phase (immediate period after the disaster occurs)

◦ Most people respond appropriately during the impact of a disaster

◦ Some people respond in a way that is disorganized and stunned and thus may not be able to respond appropriately to protect themselves or their family

◦ Several stressors may occur during the actual incident which could produce significant consequences for the person and should be taken into consideration regarding intervention

Phase I – Recommended Interventions◦ Protect: Shield individuals from additional harm or exposure

to the traumatic incident. Guard individuals from on-looking spectators and media that may have gathered.

◦ Direct: Kind but firm direction may be required. Individuals tend to be stunned, in shock, or experiencing some degree of dissociation and will need guidance.

◦ Connect: The individuals have just lost connection to the world that was familiar. Connecting in a caring, concerned, and accommodating manner may help. Help individuals connect 1) to loved ones, 2) to accurate information and appropriate resources, and 3) to where they will be able to receive additional support.

◦ Triage: The majority of those exposed to a traumatic incident experience normal stress reactions. However, some may require immediate crisis intervention to help manage intense feelings of panic or grief. Attempt to quickly establish a relationship, ensure the individual’s safety, acknowledge and validate the survivor’s experience, offer empathy, and seek additional immediate resources as needed.

Phase II – Early Post-Traumatic Phase◦ Emotional reactions will be inconsistent and depend

on the individual’s perceptions and experience◦ Reactions may include:

numbness, denial, or shock flashbacks and nightmares grief reactions to loss anger, despair sadness, hopelessness

Phase II – Recommended Interventions◦ Provide user-friendly educational materials and

presentations (ex. Choose material with plain language, preferably not above the 5th grade reading level).

◦ Provide group and individual interventions including stress-management education as environmental conditions allow.

◦ Coach managers on what to expect and how to assist team members as they recover from the incident exposure.

◦ Help individuals cope with “normal” stress reactions by providing low profile, practical, and emotional support. Emotional support in crises reduces helplessness and enhances recovery.

◦ Continue to identify individuals and families at risk for longer-term psychological problems. This identification may be done by stewards or union representatives, managers or supervisors, self-assessment, or by a professional. Make sure that individuals, union leaders and managers know about EAP services and how to access.

Phase III – Restoration Phase◦ The prolonged period of return to community and

individual adjustment or stability◦ Phase begins as rescue is completed and individuals and

communities face the task of bringing their lives and activities back to a new normal

◦ Disillusionment phase may soon follow when a disaster is off the front pages, organized support starts to be withdrawn, and the realities of losses, bureaucratic constraints, and the changes wrought by the disaster must now be faced and resolved

◦ Particularly important to remember that emotional needs may be very significant, especially for those who have been severely affected; they may only start to appear at this time

Phase III – Recommended Interventions◦ Ongoing practical and emotional

support to normalize reactions and promote hope and resiliency

◦ Follow-up with individuals and managers to address emotional needs, work performance

◦ Use of individual and/or group counseling to address symptoms

◦ Referral for psychiatric evaluation should symptoms warrant

President, Branch 458

Oklahoma City, OK

May 2013

May 2013

May 2013

Designed to reduce initial distress Foster short-/long-term adaptive functioning

and coping skills Does not assume that all survivors will

develop long-term issues Based on understanding that those

impacted will experience broad-range of early reactions

Recovery is aided by caring, compassionate responders

Establish compassionate, human connections

Calm emotionally overwhelmed survivors Assess for immediate and ongoing safety Assist impacted to identify immediate needs Connect to resources Provide education related to coping

with psychological impact

Contact and Engagement Safety and Comfort Stabilization Current Needs/Concerns Practical Assistance Connection with Social Supports Information on Coping Linkage to Collaborative Services

Keep communication simple, brief, and direct

Speak in a steady, controlled, and confident manner

Avoid statements that may devalue an individual’s experiences or feelings

Respect cultural and social diversity Know when to refer an individual for

additional help Respect confidentiality

Make connection with eye contact and mild touch (if appropriate)

Lower stimuli as soon as possible, which may involve leaving the area

Body positioning – encourage sitting/ standing in response to agitation/pacing and standing or walking with those who are emotionally blunted/shocked

Normalize symptoms Provide practical information on ways to

cope and decrease/control symptom intensity

Encourage group support for each other Remind that recovery is a process

Individual Personality Trait

+

Interpersonal Supports

=

Resilient Management of Stressful Event

Opportunities to:◦Change◦Realign priorities◦Hone talents◦Find hidden talents◦Strengthen relationships◦Develop new relationships

Self efficacy Realistic appraisal of the environment Social problem-solving skills Sense of direction or mission Empathy Humor Adaptive distancing Coping strategies unlimited by gender-role

stereotypes Positive, empathic relationships

Resiliency Enhancement by Norman, Columbia University Press, NY 2000

Find a sense of purpose Have a positive outlook Take pleasure in small joys Take an active approach to solve problems Build relationships Keep learning Expect change Be a doer Care for yourself

Burnout Stress Anxiety Fatigue Leading during a crisis Overwhelmed How to I balance everything?

Be aware of your reactions – they are normal

Prioritize Take care of yourself – eating, sleeping Maintain your regular schedule Stay connected to friends and family Call the EAP

To reach EAP: 800.327.4968 EAP4YOU.com

Bob McCullough, National Consultant◦ 314.387.4727◦ rmmccullough@magellanhealth.com