Mental Health Response to Mass Violence and Terrorism

CHAPTER VI: Setting Up Training

Training may be offered soon after a mass criminal incident to orient immediate responders, or later as part of mental health program implementation of local or State planning and preparedness activities. The focus, content emphasis, and length of the training varies according to its timing and function. Training participants may be mental health professionals only, a mixture of licensed mental health professionals and paraprofessionals, or a more diverse group that also could include crime victim assistance providers, law enforcement personnel, emergency services workers, voluntary agency providers, disaster relief personnel, medical examiner's office staff, and volunteers from faith-based organizations and chaplains. To be effective, trainers must adapt modules to the needs of the particular groups in attendance.

Each incident involving mass violence is unique. The timing and setting of its occurrence; the assumed reasoning behind the malevolent act; the ages and characteristics of the perpetrator(s), victims, affected families, and those killed; and the nature of the community and its reaction all contribute to the overall mental health impacts. Trainers need to recognize the importance of these variables and responsibly orient themselves to significant dynamics pre-existing within the community and those recently provoked by the tragedy.

Effective crisis mental health responders are flexible, easily able to establish rapport, respectful of differences among people, able to remain calm in the presence of intense emotional expression, and tolerant of ambiguity and confusion. Not everyone is suited to the rigors of responding to community crises. Participation in appropriate training can prepare workers for the unique organizational, procedural, emotional, and environmental aspects of mass criminal incident response.

While mental health providers attending the training undoubtedly will have relevant skills from prior professional activities and training, the complex and varied demands present most providers with some significantly different challenges. Prior experience with grief and bereavement counseling, disaster mental health response, critical incident stress management, hospital-based social work, faith-based emergency response, crime victim assistance and advocacy, trauma counseling, and crisis intervention can provide a helpful foundation for acquiring additional necessary skills.

Training combines lecture presentations, films, skills practice, self-awareness exploration, group discussion, and experiential learning. Participants are exposed to case scenarios and videotapes that simulate mass crisis situations, to explore their own reactions and achieve some stress-inoculation before assignment. Adult training is most effective when participants learn by seeing, doing, discussing, practicing, and receiving new information presented through multiple methods.

The training process is not designed to be a psychological "debriefing" for those personally affected by the tragedy. When it is necessary to involve workers who are also survivors, they should participate in a supportive group session before the training and also be individually assessed. Staff and program supervisors may find that these individuals' personal reactions may interfere with their functioning as mental health responders. Survivors who are also mental health responders should be cautioned about their increased vulnerability for adverse reactions and closely monitored and supported by supervisors. Trainers and supervisors should check in with local mental health responders, observe stress levels, and provide opportunities for expressing thoughts, feelings, and reactions.

Rapid Response Training

During the immediate aftermath, administrators must rapidly identify and deploy staff. If a pretrained cadre of mental health professionals does not already exist, then training becomes a priority. Even those with prior training and experience need to be oriented to the current disaster and response operation. An initial four to eight-hour rapid response training should be offered quickly and repeated as new mental health responders enter the operation.

Chapters II, III, IV, and V provide useful background and content for distribution at the training. Also, the CMHS companion Field Manual for Mental Health and Human Service Workers in Major Disasters provides a practical overview and "how to" information. It is a valuable pocket guide for readyreference in the field.

Comprehensive Training

Mental health training may take place after the immediate response phase for workers providing short and long-term mental health services. These mental health providers may be employed through a Federally funded crisis response program or may be local mental health professionals who encounter survivors as they carry out their usual roles.

The comprehensive training program described in Chapter VII requires between 2.5 and 4 days, depending on the emphases and amount of time allocated to different topics and activities. Representatives from key agencies and specialists with particular survivor groups may present portions of the training.

Comprehensive training addresses:

Human reactions to mass victimization and traumatic loss;
General principles for community trauma response and crime victim services;
Mental health interventions appropriate to each survivor group;
Local, State, and Federal response to mass community violence and terrorism; and
Mental health staff stress prevention, management, and intervention.

Selection of Qualified Trainers

Comprehensive training must be taught by a qualified mental health professional or team of trainers with collective experience and knowledge in disaster, trauma, crime victimization, and traumatic bereavement. Trainers should have formal training on these topics. In addition, the training team collectively needs prior community trauma response, crime victim assistance, and disaster mental health experience, particularly with long-term recovery issues.

Not only should the trainers have the requisite knowledge to present the material, but they also should be engaging presenters and highly skilled with group processing of emotions. Trainers must be able to model skills, as well as teach them.

Trainers coming from outside the geographic area will need to become familiar with the local community and the specifics of the recent incident of mass criminal victimization. its impact, population groups affected, extent of property damage, status of criminal justice efforts, and relief and recovery activities to date. Videotapes of news coverage, summary newspaper articles, grant applications, and emergency management bulletins can be useful sources of background information.

When training participants include recently hired staff of a Federally funded, post-disaster, mental health program, training should be consistent with funding guidelines for services. Trainers need to be familiar with these guidelines and incorporate them into training content. For example, if funding supports a limited number of counseling sessions, valuable training time is better spent focusing on interventions appropriate to that time frame.

The comprehensive training program could include different trainers with special expertise in certain topics, such as traumatic bereavement, children and trauma, or the Federal response. A crime victim assistance provider might present a session on Federal and State crime victim rights, services, and benefits. Topical presenters should also be familiar with long-term community trauma and grief recovery processes, so that their presentations are relevant to the needs of the participants. When particular cultural or ethnic groups are affected by community victimization, representatives of these groups may be included in the training. These representatives may be community leaders, social service agency workers, or educators on cultural sensitivity and competence.

Setting Up Training

The training should be held in a comfortable setting with audiovisual equipment suitable for the room and size of the group. To avoid last minute problems, trainers should anticipate possible malfunctions and plan backups. Although fewer than 30 participants is an ideal class size for training, logistics may dictate that the group be larger. Under those circumstances, having additional small group facilitators and trainers to review and give feedback on role-plays enhances the depth of the training.

Who Should Attend?

All service providers, supervisors, and administrators should attend the training. When individuals who have not been oriented to the material presented in this training provide clinical supervision or administer crisis response programs, unnecessary conflicts and inconsistencies arise. Paraprofessional counselors need initial training in basic counseling skills before attending the comprehensive training. This basic training allows them to become familiar with the role of counselor and the inherent ethical and boundary issues involved. An overview is provided in Chapter VIII.

THE COMPREHENSIVE TRAINING PROGRAM COULD INCLUDE DIFFERENT TRAINERS WITH SPECIAL EXPERTISE IN CERTAIN TOPICS, SUCH AS TRAUMATIC BEREAVEMENT, CHILDREN AND TRAUMA, OR THE FEDERAL RESPONSE.

Representatives from law enforcement, emergency services, crime victim assistance programs, faithbased organizations, the ARC, or Federal agencies assisting the community may attend the training. These individuals bring valuable information and perspective. Their presence and participation convey the importance of the multidisciplinary effort involved in emergency response and recovery. Program administrators need to balance the need for a cohesive group training with the value of including people from key agencies and referral sources. When appropriate, the training may be designed so that a broader group is included in the first day and only the mental health workers in the remaining days.

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