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Crisis Counseling Programs for the Rural CommunityForewordIn 1999 the Crisis Counseling Assistance and Training Program marks its twenty-fifth anniversary. Over the years, we have seen an increase in the incidence of floods and tornadoes devastating the heartland of America - the rural community. The goal of this publication is to improve crisis counseling services for rural populations following disaster. Determining the factors that account for the uniqueness of rural populations and communities and how those factors affect the implementation of disaster crisis counseling services are the central issues of this publication. Disaster response has many characteristics that are the same from disaster to disaster regardless of where the disaster occurs. Much of what seems unique and innovative has been more the rule than the exception. Though many elements of disaster response are predictable, each disaster presents a set of challenges and opportunities dictated by the specific area affected. Persons and communities have "personalities" that require adapting the basic tools and structures of disaster response to meet the particular needs of those impacted. In developing a mental health response to rural disasters, outreach workers drive washed out or buckled roads, attend Grange or Farm Bureau meetings, and provide short-term crisis counseling in dairy barns and farm kitchens - thus facilitating healing at the heart of the devastation. Rural communities have characteristics that require flexible adaptation of crisis counseling services, as was demonstrated during 1993, when floods ravaged a large section of the Midwest. The Federal Emergency Management Agency (FEMA) and the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (DHHS), brought together six Midwest flood States for a conference to discuss lessons learned. The results of the conference and a review of reports from past crisis counseling projects clearly show that implementing crisis counseling services in rural areas raises challenges and opportunities for innovative outcomes. This publication shares these challenges and outcomes with those who play a role in providing crisis counseling services after a disaster in a rural area. It provides an overview of key points for consideration in planning and implementing rural crisis counseling services. The intent of this publication is not to duplicate information previously published by FEMA or CMHS, but to complement it. It is assumed the reader has a basic understanding of FEMA's Crisis Counseling Assistance and Training Program. Areas of crisis counseling summarized or addressed in passing are treated in detail in other publications. A listing of resources and references (Appendixes A and B) on disaster mental health, working with children, hiring and training staff, and dozens of other topics are addressed in books, articles, videotapes, and other resources available through CMHS. Because disasters differ, occur in widely diverse areas, and affect unique groups of people, those involved in disaster response and recovery benefit from as many points of view as they can find. Any veteran of disaster crisis counseling will agree that, while experience is useful, adaptability and open-mindedness are the keys to effective crisis counseling program planning and service delivery. FEMA provided CMHS the funding to develop this publication as part of the continuing effort by both agencies to learn from previous crisis counseling experiences. FEMA and CMHS serve as conduits of information to others responsible for planning and implementing disaster mental health services. By using this publication, disaster mental health planners and practitioners can be better prepared to serve rural disaster survivors effectively. Mary Elizabeth Nelson, M.S.W. |
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