Human Face Of Disaster, December 2003

The Human Face of Disaster

Kathi Beauchesne FASAP and WORKlife Programs Johns Hopkins Hospital and University May 4, 2005

The Human Side of Disaster  Only

recently has the human side of disaster emerged as an area of serious inquiry  No one who sees a disaster is “untouched by it” (Sheppard Pratt Educational Program)

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Course Description This course will help you understand and prepare for the personal reactions you may experience in a disaster either at work or at home.  Disasters affect people in many different ways, and this course will look at what you can do at work and at home to manage before during and after a disaster with your family, friends and coworkers. 

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Purpose of the Course  The

purpose of this course is to provide information about the reactions people experience in a disaster, so that you may include preparation for emotional needs of family, friends and co-workers in your disaster plan.

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Introductions  Your

name and what you do at Hopkins  Reason for taking this class  Experience with disasters  What you would like to learn

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Plan for Today  Provide

an overview of disasters  Discuss how disasters affect people  Discuss emotional reactions to disasters and stages of recovery  Examine factors that make a difference for people  Outline work and community resources available 11/28/09

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Schedule  9:00

Introduction  9:15 Disaster Basics and Reactions  9:30 Video and Group Discussion  10:15 Break  10:25 Tools You Can Use  11:00 Special Needs  11:15 SWOT Analysis  12:00 End 11/28/09

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Disaster Definition 

 



Usually defined as overwhelming events that involve the destruction of property, include injury or loss of life, affect large communities, and are shared by many children and families (AAPWGD, 1995) Out of the realm of “normal” human experience (AAPWGD, 1995) Viewed as traumatic and can lead to stress reactions regardless of prior functioning (APA, 1980).

Also, political, bureaucratic and a media event

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Basic Principles Disaster stress and grief reactions are normal responses to abnormal situations  There is a wide range of responses  Disaster relief procedures are the “second disaster”  People do not see themselves as needing mental health treatment  Disaster mental health assistance is often more practical that psychological  Normal recovery is expected from most individuals 

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Basic Principles  Know

the warning signs that require referral  Know the referral resources before the disaster  Survivors may not want any disaster assistance

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Factors That May Cause Stress Warning Time

Location Impact Type

Environment Adapted from the American Red Cross, Disaster Mental Health Services I: Participant’s Workbook

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Reactions to Different Types of Disasters  Natural

disasters  Human-made and technological disasters  Acts of violence

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Phases of Disasters 

Pre-disaster/Pre-impact: the period before a disaster – Warning – Threat of a disaster

 

Impact: when the event occurs Recoil: immediately after the event – Rescue – Remediation

 

Post-disaster/Post-impact: days to weeks after the event Recovery and reconstruction: months to years after the event

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Phases of Disaster  Heroic  Honeymoon  Disillusionment  Reconstruction

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Emotional Phases of a Crisis  Shock  Reaction  Processing  Reorientation

– a sequence of getting better – do not follow one another systematically

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Signs and Symptoms of Distress  Cognitive

(Thinking)  Emotional  Behavioral  Physical  Spiritual

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How Disasters Affect People Video: Berkeley-Oakland Fires

Small Group Discussion  What

reactions did you see

– Emotional reactions – Cognitive reactions – Physical reactions  What

factors may cause stress and difficulty?  Did the type of disaster make a difference in the reactions? 11/28/09

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Break Take 10 minutes

Recovering Emotionally         

Try to return to as many of your personal and family routines as possible. Get rest and drink plenty of water. Limit your exposure to the sights and sounds of disaster, especially on television, the radio and in the newspapers. Focus on the positive. Recognize your own feelings. Reach out and accept help from others. Do something you enjoy. Do something as a family that you have all enjoyed in the past. Stay connected with your family and/or other support systems. Realize that, sometimes, recovery can take time.

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Remember The vast majority of people are able to recover quickly and return to duty quickly soon after an event  Some people experience some of these reactions, but the variety of response is very broad  Most people who find themselves in the middle of a disaster want to do the right thing, and people will pull together 

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Tools You Can Use Be prepared  Self-care  Mental health pyramid  Emotional first aid  Small group intervention  Large group intervention  Pastoral care  Rituals  Workplace benefits that can help 

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Be Prepared – Develop a family disaster plan – Develop a work disaster plan – Put together a disaster supplies kit – Learn about disasters and their impact – Prepare financially – Know your resources – Volunteer – Handout: Are you ready? 11/28/09

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Self-Care Protect Direct

Connect Select

Diane Myers, unpublished manuscript, National Center for PTSD Fact Sheet http://www.ncptsd.org 11/28/09

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Mental Health Pyramid  Helping

people help themselves  Support from family and social network  Help from institutions and NGOs  Help from the social welfare system  Local and regional mental health  Disaster mental health 11/28/09

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Emotional/Psychological First Aid and SACC Model 

 



Emotional/Psychological First Aid: A set of life skills used by lay citizens and emergency responders to provide the support a person who is emotionally shocked needs immediately following a crisis event. Not therapy Designed to stabilize, meet basic needs, assist in problems-solving, regaining sense of control and facilitating access to other resources if needed. Essential skills: active listening, caring attitude, empathy, non-judgmental approach, commitment, patience and self-care

Source: Trauma Intervention Programs, Inc., Sheppard Pratt Educational Programs, 2005, Everely & Flynn, 2004 http://www.tipnational.org/emotion.html

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Small Group Crisis Intervention  

 

 

Reserved for natural cohorts (< 20) Sharing similar levels of trauma exposure/ psychological toxicity Participation should be voluntary Psychologically “fragile” individuals should be excluded “Active” leadership essential May be used for “decompression” or transition (see Everly & Langlieb, 2003; Everly, 2003, IJEMH, for guidelines and cautions)

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Large Group Crisis Intervention Largely informational in nature (“town meeting”), may provide rest & nutrition (respite center)  May be useful in schools, group residences, workplaces, disaster venues  Basic steps: Assembly, Declaration of relevant facts, Discussion of reactions, Discussion of resources and follow-up  (see Everly & Langlieb, 2003, IJEMH; Castellano, 2003, IJEMH) 

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Pastoral Care          

Opening or Creating safe, sacred space Prayer Partners with those seeking intercession Death Notification team members Acute Grief ministry at Morgue site World-faith rituals among victims at scene Well-being calls to families of public safety personnel and reciprocal notification of same MBWA in rehab, reception, and mass-care areas Worship leadership in mass-care settings Participation in CISM-interventions Meaning-making rituals e.g. death of pets, loss of homes, absence of human remains

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Workplace Benefits That Can Help       

Funeral leave Family & Medical Leave Act Short term disability Long term disability Leave of absence Emergency loans Child care and elder care resource and referral

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Informal policies

 

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Flexible work schedules Leave sharing

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How Disasters Affect People: Groups with Special Needs 

People with

– Disabilities – Low income

 

Racial or ethnic minorities; non-English-speaking people, refugees People – living alone – new to the area

     

Single parent families Institutionalized or mentally ill persons Children Elderly persons Previous disaster/trauma experience People with money

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How Disasters Affect People: Our Children and Families Death or physical injury to a family member;  Intense emotional demands  Extended exposure to danger, environmental or human destruction  Loss of communication with loved ones  Loss of family dwelling or possessions;  Relocation (school changes);  Job loss; and  Parental disorganization or dysfunction 

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Factors that make a difference: Children

 Ensure

basic survival and comfort  Ensure basic personal space  Address physical health problems and concerns  Reassure about safety and the whereabouts and status of loved ones—reunite with families  Help children and families take practical steps to resolve problems Young, Ford, Ruzek, Friedman, & Guzman (1998)

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Factors that make a difference: Children and Families  Keep

the family together  Calmly and firmly explain the situation  Encourage children to talk; listen to what they say and if possible, include the family in on the discussion  Include children in recovery activities  Offer reassurance 11/28/09

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Death  Sudden

death of an employee  Death of an employee  Death of a family member

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Steps to Consider        

Make direct contact and express condolences Appoint one person to act as liaison with the family Guide the family to appropriate JHH/JHU resources—Benefits Notify coworkers personally and the community by e-mail and include funeral arrangements Make sure your department and school are appropriately represented at the funeral Allow time-off with pay to attend services Notify FASAP if necessary Contact Public Relations, if necessary

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Cultural Differences to Consider 

   

Nature of beliefs toward life, death and the hereafter Funeral rites Whether grief is public or private Is it appropriate to talk about death? What language is used regarding death?

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Talking about grief 



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It is ok for people to talk about their loss at work It is ok for people not to talk about their loss at work Everyone is different – Ask the grieving person what they want

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Group Exercise You are with a group of colleagues in a meeting when you hear that there has been a terrible explosion on in the Harbor Tunnel. It is about 9:00 am, and several of your coworkers are in tears believing that they have friends and family who might have been in the tunnel.  Prepare a SWOT Analysis that addresses the “human face” of this disaster. 

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SWOT Analysis Strengths: What will your group do well? What strengths do you bring to this situation?  Weaknesses: What would keep you from doing better in this situation? What would your group avoid? What would they do badly?  Threats: What obstacles would you face?  Opportunities: What opportunities are available to you to handle this situation? 

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Group Reports 3 minutes each

Resources  JHH

Policies  JHH/JHU Typology  Information for Families  Fact Sheets  Disaster Plans  Resources

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Kathleen Beauchesne Faculty and Staff Assistance Program, Student Assistance Program and WORKlife Programs http:www.fasap.org http:// www.hopkinsworklife.org 410-955-1220 443-997-6605

How Disasters Affect Communities  Dissipation

of community cohesion due to death and injury  Vulnerability and exploitation due to disaster and media sensationalism  Potential for recurrence

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Disasters Affecting Communities: JHU Definition 

Institutional Crisis

– disrupts normal operations of the university or poses a serious threat to persons, property, or the university's reputation, – requires a quick or immediate response and coordinated, efficient management, and – requires a response with procedures and resources whether human, material or logistical--beyond the capability of the organizational unit or facility where the event has occurred



Distinction Between "university-wide crisis " and "local crisis

– require some sort of university-wide response, and crises (or emergencies) – addressed locally by the divisions and departments with the responsibilities for the operations in which these events occur

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JHU Committee on Crisis Management: Typology of Disasters and Response An identification of the types of crises that might arise at an institution like Johns Hopkins  A plan for dealing with all aspects of crisis management, including, but not limited to, physical security of people and facilities, public relations, leadership responsibilities, and communications, both internal and external  Necessary steps to implement the crisis management plan 

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JHU Typology  Specific

to senior management only  Catastrophic and significant events  Criminal events  Disease and epidemics  Manpower shortage events  Technological or safety events  Utility or structural events  Weather emergencies 11/28/09

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How Disasters Affect Communities 

JHU includes:

– Power outages – Water/sewage system breakdowns – Telecommunications outages – Computer systems disruptions



Larger impacts

– Roads/bridges damaged – Injured, missing or dead people – Buildings damaged or destroyed (and also contents) – Economic disruption

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How Disasters Affect People: Definitions of Crisis  “A

crisis is a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms.”

James, R.K. & Gilliand, B.E. (2001). Crisis Intervention Strategies. Wadsworth/Thompson Learning. Belmont:CA. p.5.

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Bereavement Leave – 3 days paid leave for death of immediate family member including same sex domestic partners

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Family and Medical Leave – 12 weeks of leave per year – Must use sick or vacation time – Birth of child, serious illness to self, child, spouse or same sex domestic partner

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Disability Policies  Short

Term Disability

– Employee must enroll  Long

Term Disability

– Employee is automatically enrolled

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Leave of Absence – Granted at the discretion of the department – Department head can grant leave 90 days or less – VP or Dean can grant leave up to a year

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Flexible Work Schedules

 

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Flex-time vs. Flex-place Approved at the discretion of the supervisor

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Leave sharing 

Sick Pool for some JHU departments (pilot program) – Cannot donate unless you have 60 hours of accrued sick time – Given as an anonymous donation

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Emergency Loans: JHU – Available every 6 months – Approval of supervisor required

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Emotional Reactions to Disasters: Stages of Emotional Recovery  Survival:

1st 24 hours  Support: 1-7 days  Adjustment: 2-8 weeks  Resolution: 2-8 months  Reconstruction/recovery: 2+ years Adapted from Lewis, G. Presentation at Employee Assistance Professional Association, November 2003.

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