Staff Mental Health Services

Question 1

Primary role of DMH

Answer 1

A primary role of DMH is to provide support for disaster workers—before, during and after the response.

Question 2

DMH workers help?

Answer 2

DMH workers help other disaster workers manage their stress through education, individual or group contacts; surveillance of stressors and worker functioning within the working environment

Question 3

Key Characteristics and Helping Behaviors of Disaster Mental Health Workers

Answer 3

Adventuresomeness, sociability, calmness, systems savvy, and therapeutic acumen

Question 4

Adventuresomeness

Answer 4

The inclination toward curiosity and learning from experience as well as the willingness to develop creative solutions to complex problems.

Question 5

Sociability

Answer 5

To work with people who may be experiencing extreme stress, and to maintain the stance of a sensitive and observant listener and helper. Does not mean over-involvement or pseudo-friendliness

Question 6

Calmness

Answer 6

Working and living conditions are often chaotic: noisy settings, long hours, substandard lodging, unstructured schedules, ambiguous roles and rules – these high-stress circumstances call for emotional poise.

Question 7

System Savvy

Answer 7

The disaster mental health professional represents a distinct interest – that of supporting and enhancing the psychosocial safety and functioning of helpers, survivors, and their community. By becoming familiar with the scope of disaster relief operations (i.e., community, state, and national political arenas), the mental health professional can better assume the role of an impartial mental health advocate.

Question 8

Therapeutic Acumen

Answer 8

To provide therapeutic assistance without “therapizing” disaster survivors or workers, the mental health professional’s perspective must be grounded in empathy, genuineness, and respect.

Question 9

Empathy

Answer 9

Ability to help the survivor feel that he or she is understood.

Question 10

Genuineness

Answer 10

Ability to reduce the emotional distance or alienation between the survivor and oneself.

Question 11

Unconditional Positive Regard

Answer 11

Ability to convey respect for the survivor.

Question 12

Listening

Answer 12

Ability to utilize array of listening skills

Question 13

Empathic Behaviors

Answer 13

Express desire to comprehend survivor
Discuss what is important to survivor
Refer to survivor’s feelings
Correctly interpret survivor’s implicit feelings

Question 14

Genuine Behaviors

Answer 14

Friendly and open
Spontaneous rather than rigid or overly formal
Actions congruent with intent

Question 15

Respectful Behaviors

Answer 15

Be on time for appointment and meetings
Make statements that express respect for the survivors
Express non-verbal attentiveness and concern
Summarize survivor’s messages accurately (e.g. appropriate eye contact and tone of voice)

Question 16

Listening Behaviors

Answer 16

Ask clarifying questions
Paraphrase survivor’s statements accurately
Verbally reflect survivor’s feelings accurately
Ask open-ended questions
Help clarify survivor’s mixed ( incongruent) messages

Question 17

Behaviors providing therapeutic structure

Answer 17

Recognize overt and covert problems with stress
Recognize antecedent conditions that triggers stress responses
Understand how survivor’s stress response to stress influences post- disaster behavior
Educate survivors about stress response
Syndromes and stress management strategies

Question 18

Provide therapeutic structure

Answer 18

ability to conceptualize survivors’ stress-related problems

Question 19

Disaster mental health teams take two basic forms.

Answer 19

Standing Teams
Ad hoc Teams

Question 20

Standing Teams

Answer 20

are formed before or shortly after disaster occurs (i.e., by agencies such as community mental health centers or the Department of Veterans Affairs; or by mental health and emergency service practitioners).

Question 21

Ad hoc Teams

Answer 21

are formed at disaster sites, often joining together several standing teams to provide a coordinated response.

Question 22

Staffing Roles

Answer 22

Disaster Team Leader
Direct Service Providers ( a) Field Coordinator(s); b) First Responders; c) Back-up teams )
Ad hoc Secretarial Support.
Program Analyst / Researcher

Question 23

Direct Service Provider Selection Considerations

Answer 23

1. Possess a mental health clinical license.
2. Be available for service on “hours to days” notice for 10-14 day assignment.
3. Have letters of reference indicating that the candidate has:
   a) A high tolerance for difficult working conditions which may include: - long hours - substandard lodging, primitive facilities - unstructured or ambiguous situations - intense political competition - rapid change;
   b) Ability to establish rapport with people of various ages, ethnicity, and social, economic, and educational backgrounds;
   c) Training and experience in emergency mental health debriefing methods;
   d) Organizational “savvy” and political sensitivity;
   e) Ability to give educational group presentations to survivors, helpers, community groups;
   f) Training as a disaster mental health volunteer with the American Red Cross.

Question 24

All members of the DMH Team require

Answer 24

specialized training because many of the intervention skills needed differ from those used in traditional outpatient or inpatient clinical work

Question 25

Content of training of DMH team should include the following:

Answer 25

* impact of disaster on individuals, disaster workers, organizations, and communities; * factors associated with adaptation to disaster-related trauma; * at-risk groups and individuals in the wake of disaster; * specific interventions to match the needs of specific at-risk groups and individuals in each phase of disaster impact (i.e., on-scene, early post-impact, and restoration phase) * operational guidelines for applying disaster mental health interventions, including defusing, debriefing, death notification, and ritual and psychoeducational interventions; * operational guidelines for disaster mental health worker stress management; * pertinent issues involved in forming and operating a disaster mental health team; * an overview knowledge of the Federal Response Plan and the disaster mental health team’s and practitioner’s liaisons to other disaster response organizations

Question 26

Development of standard operating procedures address?

Answer 26

Each disaster mental health team will need to develop standard operating procedures to address fiscal, skills development and maintenance, mobilization, field services, return to home site, and evaluation practices

Question 27

These considerations aside, standard operating procedures should address:

Answer 27

a. Fiscal b. Mobilization c. Field Procedures d. Demobilizations e. Education f. Program Policy and Evaluation

Question 28

a. Fiscal

Answer 28

* Fiscal responsibility mechanisms * Budget for equipment (cell phones, flashlights, identification badges, etc.) * Budget for logistical support (transportation to and from site, on-site vehicles) * Budget for lodging and per diem expenses * Budget for miscellaneous expenses (postage, phone bills, laptops, miscellaneous stationary supplies, etc.)

Question 29

Mobilization

Answer 29

* Equipment procurement procedures * Staff notification procedures * Staff check-in procedures * Logistical support (providing staff transportation, lodging, and per diem expenses)

Question 30

Field Procedures

Answer 30

* Conduct of needs assessment * Coordination of staff assignments, frequency of status reports, scheduling * Liaison with other agencies · * Mitigation and monitoring of stress levels of staff * Intra-operation defusing * Post-operation debriefing

Question 31

Demobilizations

Answer 31

* Demobilization procedures * Reintegration back into regular assignment * After action report formats * Intra/inter-agency coordination

Question 32

Education

Answer 32

* Development & distribution of educational materials for the public (e.g., common stress reactions in adults, elders, children; stress management techniques; other information) * Continuing education of team - Trainings - Exercises

Question 33

Program Policy and Evaluation

Answer 33

* Development of Disaster Mental Health Team policy including membership process, administrative structure, liability, referrals, clinical and statistical reporting forms, expense records, etc. * Development of program evaluation mechanism

Question 34

a. Stressors Affecting Disaster Mental Health Workers Assisting Survivors

Answer 34

* Exposure to survivor grief, terror, shame, guilt, confusion * Vicariously experiencing death and injury to children and adults * Pressure to provide answers/solutions to insoluble problems * Prolonged physically and emotionally demanding activity with few if any breaks * Separation from loved ones; inability to protect or communicate with loved ones * Direct threats to one’s own physical safety * Witnessing or experiencing grotesque destruction and its aftermath * Personal loss caused by the disaster (e.g., home, personal belongings)

Question 35

b. Common Stress Responses of Disaster Mental Health Workers

Answer 35

* Compassion strain: Frustration, psychic numbing * Vicarious traumatization: Shock, fearfulness, horror, helplessness * Hyperarousal and hypervigilance * Confusion and disorientation * Urge to “anaesthetize” (e.g., substance abuse, excessive sleep)

Question 36

Acute and Chronic Stress Disorder Indicators

Answer 36

* Compassion fatigue: Demoralization, alienation. * Ruminative or compulsive re-experiencing * Attempts to “overcontrol” relationships * Withdrawal and isolation * Addictive attempts to anaesthetize

Question 37

Stressors Associated with Disaster Mental Health Work

Answer 37

a. Stressors Affecting Disaster Mental Health Workers Assisting Survivors b. Common Stress Responses of Disaster Mental Health Workers c. Acute and Chronic Stress Disorder Indicators

Question 38

Before an Assignment

Answer 38

Personal Preparation Managing personal resources Safety of Family Members Social and Organizational Support

Question 39

During an Assignment

Answer 39

Working With a partner Limit length of shifts Use stress management techniques Keep a notebook Defuse regularly Call home Regularly Closures

Question 40

After an Assignment

Answer 40

Returning home

Question 41

Certain values and beliefs often held by helpers may may actually interfere with self-care. For example:

Answer 41

“It would be selfish to take some time to rest” “Others are working around the clock, day after day; I should too” “I should be strong enough to work all the time” “Needs of survivors are more important than the needs of helpers” “I can contribute the most by working all the time”

Question 42

Obstacles to Self-care

Answer 42

Thus, barriers to self-care come from the demands of the disaster environment, but also from attitudinal barriers on the part of some disaster workers. Because an exhausted disaster worker is at risk to perform less well, become irritable, and solve problems less ably, it is important for helpers to re-examine their attitudes and, when on assignment, be alert to these obstacles to self-care

Question 43

Therapeutic Acumen

Answer 43

empathy, genuineness, and respect