Disaster Relief and Crisis Counseling

Psychosocial Issues for Children
and Adolescents in Disasters

GUIDELINES FOR CAREGIVERS,
MENTAL HEALTH AND HUMAN
SERVICE WORKERS

Disaster work almost always requires training, supervision, and consultation of human service workers, many of whom have little or no training in disaster issues. This section is directed to the various roles professionals, parents and caretakers of children may be called upon to serve during and following a disaster event. Side by side, professionals and paraprofessionals alike can work together to utilize basic skills in responding to the special needs of children who have experienced a disaster.

The hallmark of a disaster mental health operation is to assist persons in dealing with their emotional response and recovery following the trauma of a major disaster event. The intended outcome is to return persons affected by the disaster to their pre-disaster level of coping. Since most disaster survivors do not perceive themselves as ill or in need of mental health services, crisis counseling programs emphasize outreach to communities, neighborhoods, churches, schools, and existing social networks to help persons who typically would not seek assistance from mental health service agencies. Hundreds of crisis counseling programs across the nation have repeatedly demonstrated that paraprofessionals indigenous to the affected community perform most effectively in the role of providing basic crisis counseling services. In these programs, it has been demonstrated that special services and programs for children have been developed within schools, extended school programs, communities, youth organizations, and summer recreational programs.

Children may have an extensive support system, but usually do not have the life experiences or coping skills that would assist them in responding to the dramatic changes in their lives caused by disaster. Knowing what kind of assistance is available in the community, through government, religious and private agencies, is critical in responding to the needs of children and families in disasters. Most services will be found in local government and private agencies. Professionals, paraprofessionals and caretakers such as teachers need to learn as much as practicable about the community resources specifically offering services to children. Examples are family services agenices, child guidance agencies, child care centers and after school programs.

However, due to the unpredictable nature of outreach work and the potential for engaging persons who may significantly benefit from professionally delivered mental health services, it is crucial that outreach workers are provided with sufficient levels of supervision from trained mental health professionals.

The FEMA/CMHS Crisis Counseling Assistance and Training Program (commonly referred to as the Crisis Counseling Program) that follows a Presidentially declared disaster employs intervention models that mobilize a broad spectrum of persons with a great diversity of experience and training. Crisis Counseling Programs emphasize outreach to communities, neighborhoods, schools, and other networks to help persons who typically would not seek assistance from mental health service agencies. Hundreds of Crisis Counseling Programs across the nation have repeatedly demonstrated that paraprofessionals indigenous to the affected community perform most effectively in the role of outreach workers. Outreach workers must have certain communication skills and other attributes necessary for successfully conducting their roles, which are discussed in other CMHS publications. However, due to the unpredictable nature of outreach work and the potential for engaging persons who may significantly benefit from professional mental health services, it is crucial that outreach workers are provided with sufficient levels of supervision from trained mental health professionals. Below are examples of the broad range of supervisory roles mental health professionals provide:

Supervision Through Didactic Training - Increasing the knowledge base of workers through brief in-service sessions explaining the basics of human behavior and development, assessing survivor needs, and providing tips on engagement.

Group Supervision - Team building through weekly review of current events and activities of the outreach workers. This includes discussing recent interactions with disaster survivors, problem-solving unique situations, and stimulating innovative thinking among outreach team members. Individual Supervision - Supporting each individual team member with strategies for managing administrative workload, emotional/professional commitment, personalization of outreach experiences, development of dependency relationships, and issues of transference and counter transference.

Crisis Counseling Programs often engage mental health professionals to provide specific information about working with special populations. After a disaster, persons in a community who would have little reason to meet each other now find they share a bond through the common challenge of post-disaster recovery. Outreach workers, volunteers, unmet needs committee members, emergency operations personnel, clergy, housing specialists, and others may be confronted with situations and persons with special needs with whom they have little or no experience. Children with serious emotional or behavioral disorders and their families are an example of a special population that disaster recovery personnel may encounter in shelters, disaster recovery centers, and other sites. Brief training sessions for operations staff by mental health professionals can alleviate much apprehension of personnel and equip them with information and strategies that will result in successful outcomes for all involved parties. Mental health professionals may be called upon to provide ongoing training on specific topics to crisis counseling staff. Examples include the following: specialized information topics about case finding techniques of in-home intervention, working with children with developmental disabilities, issues related to family interventions, child abuse, and recognizing maladaptive patterns of alcohol and drug use.

Mental health professionals also play a significant role as consultants to Crisis Counseling Programs. A common role of consultants is to provide orientation and ongoing project development training to the crisis counseling staff. In the context of children and their recovery, the main purpose of the consultant is to sensitize project staff to the mental health needs of children and families in their recovery from the disaster and to assist project staff to integrate their services through interagency collaboration with other child-serving agencies. Many communities throughout the country have developed Child and Adolescent Services System Programs (CASSP). These children oriented systems of care are designed for at-risk children with serious emotional disorders. In a time of a disaster, these agencies may represent significant resources to crisis counseling recovery programs. Often the child mental health professionals in a community play an important role in this network. They can provide consultation on how interagency collaboration is done in a specific community, as well as which combined community and agency resources may be available to disaster survivors. Consultants can also assist staff with issues of organizational boundaries, working with school administrators, referral criteria for various community services, and role clarification.

Responding to the needs of children and families who are coping with the aftermath of a major disaster is physically demanding and emotionally charged work. This is true even for the seasoned mental health professional who is accustomed to the fast paced, often chaotic environment of mental health crisis intervention work. A distinguishing characteristic of disaster mental health work is that often the worker identifies on a personal level with survivors and cannot find a quick method for establishing psychological distance with the persons seeking assistance. Additionally, the disaster mental health worker may also be a survivor of the disaster and must deal with issues concerning his or her own recovery and that of family members.

Acknowledging the high stress load of this work and implementing an array of stress reducing strategies is an important role for mental health professionals. Examples of typical stress management activities linked to Crisis Counseling Programs are: routine defusing and debriefing sessions during all phases of recovery operations, identifying a stress management counselor outside the project's administrative chain of command, offering ongoing stress management training sessions, providing auto-relaxation techniques, and assisting staff to recognize the signs and symptoms of burnout in survivors and staff.

Burnout is the normal result of increased demands and overwork after a disaster and may appear as persistent physical and emotional exhaustion, unrelieved feelings of fatigue, marked irritability, and a decrease in the individual's desire and ability to work effectively. With respect to staff working with children and families, burnout is often the result of overwork and over commitment. Burnout among project staff may be very harmful not only to the worker, but also to the disaster survivors who are seeking assistance. Project staff may become irritable with survivors and make promises they cannot possibly keep. CMHS strongly recommends that staff responsible for implementing disaster mental health services seek consultation on the development of a comprehensive stress management program as an integral part of their disaster recovery operations.

Most parents are capable of assisting their children in overcoming fears and anxiety related to a disaster event. However, when the situation seems beyond their reach, assistance can easily be provided through pediatricians, family physicians, or mental health and school counselors. Understanding and helpful intervention can reduce a child's fears and prevent more serious problems from developing. The manner in which adults, caregivers and mental health professionals help children to resolve their emotional turmoil at uncertain times may have a lasting effect on the child. Knowing the type of assistance that is available in a community is necessary in responding to the needs of children after a disaster.