Disaster and Crisis: Social Work Responses to the Impact of World Events

Helen Wilson Harris, LCSW

Eleanor Roosevelt, You Learn By Living “Courage is the strength to face pain, act

under pressure, and maintain one’s values in the face of opposition. You gain strength, courage and confidence by every experience in which you really stop to look fear in the face. You are able to say to yourself: ‘I lived through this horror. I can take the next thing that comes along.’”

Psalms 34: 19

“Many are the afflictions of the righteous: but the LORD delivereth him out of them all.”

Objectives: Examine the nature of uncertainty, crisis, stress and

grief that come with disaster Differentiate between crisis and grief Develop specific helping strategies for social

workers assisting clients to manage disaster and tragedy

Develop specific strategies for social workers assisting others through crisis.

Review self help strategies.

Sources: Coping with Public Tragedy ( 2002 Hospice

Foundation of America) Edited by Marcia Lattanzi-Licht and Kenneth Doka

The National Center for PTSD, Special Edition, Disaster Assistance (2001)

Growing through Grief after Sudden Loss (1999 Hospice Foundation of America) Edited by Kenneth Doka

Disasters, Trauma, Public Tragedy Disaster: collective traumas…according to

Barton, “collective stress…members of a social system fail to receive the expected conditions of life due to external or internal sources

Trauma: extraordinary events that threaten survival

Public Tragedy: large scope with which the public identifies Doka, 2002

What is your first memory of public disaster or tragedy? The assassination of

President Kennedy? MLK Jr? Robert

Kennedy? Mount Carmel? Columbine? Oklahoma City? 9/11? A natural disaster?

Public Tragedies in our Living Rooms We live in an increasingly small world Major events have global impact, including impact

on our lives The media brings distant events into our living

rooms Live and constant coverage immerse people in the

details of tragedy Our community is called on to respond to the needs

of our neighbors

Layers of stress and concern: Fear and anxiety with uncertainty of future Sense of helplessness and feeling out of control Normal life stressors of job and family may continue Exacerbation of grief that comes with losses…death,

moves, relationships… Confusion from losing the assumptions we have

about the world as a safe and predictable place Multiple funerals and images of the grief of others

Understanding the phases of tragedies:

The initial event, early aftermath…i.e. Crisis Phase

The short-term aftermath…i.e. Processing Phase

The long-term aftermath…i.e. Adaptation Phase Licht and Doka

The Processing Phase…. The folks at Seventh and James are still in

crisis but are beginning to experience safety and the meeting of their basic needs.

Many are now beginning to try to make sense of this. The prevailing questions will be “what happened?” and “why?” as well as “what now?”

Crisis Phase: On site and here when a secondary crisis occurs First responders Safety: Police,

Firefighters Medical Response:

EMT, Doctors and Nurses

Issues are safety, preservation of life, ending the crisis

Processing Phase Tragedies affect many people: survivors,

witnesses, first responders, bereaved, later responders, and members of the community

Responses will vary significantly and may include physical response, emotional reactions, cognitive reactions, and spiritual reactions. Lattanzi-Licht and Doka

Crisis Management means: First focusing on basic needs: Shelter, safety,

sustenance, information, protection Second, allowing those affected to begin to

figure out what happened…tell their story, process the event and its meaning for them.

Always validate and normalize the responses ….listen carefully…reflect the language

The gifts of time and presence…….

Assessment is essential Hearing the story will help you assess the needs and the

strengths of each person (Strengths include their resilience…how they have managed crisis is times past…)

Listen each time as though it is the first time you heard the story

Assess strengths…support system available to the survivor

Assess spiritual beliefs/source of strength Be careful of trite, glib religiosity

Adaptation Phase Part of your assessment will include

awareness of how long you will be available to help

Contract for work and for referral Remember that crisis work eventually leads to

grief work which is LONG term Encourage the use of ritual and the arts to

personalize the experience and provide formal, structured support. Lattanzi-Licht and Doka

How Long Will This Take? The Adaptation Phase

for the survivor may take years

Contract for the time you will be able to be present

Make referrals as needed

There is NO end point or closure

Avoid the term “letting go…” People do not “let go” of memories or loved ones or

dreams or wishes… There is great resistance to “letting go.” It feels like

giving up. We do, however, over time, learn how to weave

together the threads of our lives A better metaphor is to integrate the relationship and

the event into our lives. (These folks may not be ready to believe this….)

Each relationship and experience becomes part of who we are….

Concrete ways of helping… Provide material goods: Provide your time and

listening ear Participate in your community’s disaster response

team/disaster planning efforts Network with voluntary organizations to work

together to respond to disaster Give blood Develop in your workplace organizational policies to

support employees during times of crisis

Debriefing Tips….the beginning of counseling…. Protect the privacy of survivors and their families Provide support as families get new and painful

information Plan and publicize healing ceremonies Provide information on coping strategies Be careful about providing information to the

media Help the helpers… Lattanzi-Licht and Doka

Critical Incident Stress Management… Mitchell model to help first

responders Follows a traumatic event Coping skills are

overwhelmed Goal, to prevent or limit

development of PTSD Provide distance Demobilize or debrief Lattanzi-Licht and Doka

Debriefing includes… Explain process and ground rules (not

psychotherapy…not operational critique) Allow description of what happened and respective

roles Explore “first thoughts” and event processing Facilitate ventilation: What was worst? Identify symptoms of distress Normalize crisis reactions Teach stress management and coping skills Summarize, provide follow up as needed Doka

Other options: Defusing….small group discussion of

traumatic event Informal Held immediately after an incident Designed to reduce tension Focus on facts of the crisis and reactions Offer family/organizational consultation Offer follow/up and referral Lattanzi-Licht and doka

Other Crisis Intervention Models Beverly Raphael: When Disaster Strikes Armstrong, O’Callahan and Marmer’s Red

Cross adaptation of CISD: Multiple Stressor Debriefing Model

National Organization of Victim Assistance (NOVA): Safety and security, ventilation and validation, prediction and preparation

Lattanzi-Licht and Doka

Resources www.hospicefoundation.org www.whyy.org/widerhorizons/caringcom.htm

l www.redcross.org/services/disaster www.nvoad.org (national voluntary

organizations involvement in disasters) www.imhi.org/dealing_with_disaster.html for

helping children with disaster

Government Agencies…. Federal Emergency Management Agency

(www.fema.gov) Robert T. Stafford Disaster Relief and Recovery Act:

Center for Mental Health Services within Substance Abuse and Mental Health Services Administration

Small Business Administration Disaster Unemployment Assistance IRS, USDA

Not-For-Profit Organizations National Voluntary Organizations Active in

Disaster American Red Cross (www.redcross.org) National Organization for Victim Assistance Salvation Army Mennonite Disaster Service Church related disaster response services

Professional Organizations American Academy of Experts in Traumatic Stress

(www.aaets.org) Association of Traumatic Stress Specialists

(www.atss-hq.com) International Critical Incident Stress Foundation,

Inc. The International Traumatology Institute Hospice Foundation of America (www.hospice

foundation.org) National Hospice Organization

Other Resources American Psychological Association Disaster

Response Network (www.apa.org) America’s Heroes of Freedom (

www.americasheroes.us) Anxiety Disorders Association of America (

www.adaa.org) Association of Death Education and

Counseling (www.adec.org)

Let others participate in helping as well…. Ask for help and support Take tasks one at a time Practice good self care….eat healthy, take breaks,

rest, exercise, look for the positive Engage in activities that are relaxing for

you….sitting by the water, taking a walk, spending time with a favorite pet, listening to music, prayer, Bible reading

Do something….give money, blood Natl Center PTSD

Turn off the news…. Distract yourself by

doing something you enjoy. It is not wrong to laugh again. You may be the one who can set the example for others that self care helps us continue to give to others.

Helping the Children….

Gear interventions to the child’s age and developmental level…. For very young children, keep routines as

much as possible, avoid separations, maintain calm, limit exposure to the trauma, expect regression, help provide language for the feelings, and play, play, play to enable the child to play out the situation. National Center for PTSD

For young to latency age children Listen to the telling and

retelling Allow feelings, including

fear Limit exposure Expect regression and

acting out Set limits for safety Maintain routines Play, play, play it out National Center for PTSD

And then there are teens…. Listen, listen, listen Provide contact with

peers Affirm feelings; model

seeking support Give them something

positive to DO Encourage activities

they enjoy with others National Centger for PTSD

When is it time for referral? Consider grief complications…ie suddenness

of the death, troubled relationship, violence, arousal of fear

Consider support available Consider coping skills and other stressors Consider length of difficulty…i.e. duration of

distress Always assess for suicidal ideation.

Grief follows Crisis…. During the Adaptation Phase, grief begins to

manifest itself Grief includes emotional, physical, social,

intellectual and spiritual responses to loss Loss can include loss of safety, loss of

assumptions about the world, loss of relationships, loss of loved ones, loss of property, etc.

Physical Grief Physical sensations….lump in throat,

tightness in chest, weak knees, etc. Experience of cold…blood flow to internal

organs makes extremities cooler Increased vulnerability to illness because of

stress to the immune system Increased vulnerability to accident because of

cognitive distractability

Emotional responses to grief… Most models tell us about the feelings of

grief… Shock/denial Anger Bargaining Despair Acceptance And what about guilt, sadness, loneliness?

Cognitive impact of grief….

Shorter attention span

Difficulty learning new material

Difficulty concentrating

Low energy

Social implications of grief… Those who are

bereaved feel robbed…and that experience can distance them from others

No one understands I’d rather be alone Laughing is too hard

Spiritual Implications….Faith and practice Expectations of others (and often of

ourselves) that Christians have hope, and faith, and strength…..

Translates to an expectation that Christians aren’t anxious, and shouldn’t be sad…..

So, Christians should handle anything…and do it joyfully and with celebration.

The truth is…… Our faith and rituals

ARE a great source of strength to us.

AND we mourn…and we hurt…not as the world mourns…but mourn we do.

Defusing PTSD….and then….