Crisis Counseling Programs for the Rural Community

Rural Crisis Counseling Project Staff

Recruitment and Staffing

The quality of staff and their understanding of the program are essential to the success of the rural crisis counseling project. Staffing issues that impact rural crisis counseling projects include the pool of individuals available for hire, the hiring of people representative of the population to be served, and their responsiveness to training and supervision. The following generalizations regarding staffing can be made based on the experience of past rural disaster projects:

Most staff hired will probably not have previous disaster experience.

If workers are hired from the impacted area, the majority will not have had experience working in a disaster relief program. Some may have personal disaster-related life experience, but working with this program will be their first formal involvement. This lack of experience places a great deal of importance on the areas of training, supervision, and staff support.

Staff hired for outreach should represent the groups they are to serve.

Rural disaster programs use a high percentage of local people in their outreach and crisis counseling efforts. Almost without exception, the use of indigenous workers is integral to program success. Project COPE in Ventura County, California, enlisted people with serious and persistent mental illness to perform outreach to other people affected by the disaster who had a mental illness. This approach was highly successful (Northridge Earthquake Final Report, Ventura County, California, 1995).

Rural outreach workers often have a car as their office, find themselves making contacts with people they already know, and often receive calls at home at all hours. Consistent training and supervision on managing these unusual circumstances are necessary not only to protect the well being of the worker, but to protect the worker's family functioning as well.

Staff hired from small towns and country areas will be more easily received.

In many rural agencies and organizations, it is more likely that one will know or have some acquaintance with the people contacted. This familiarity provides a greater sense of safety and assurance for the worker in making the rounds from house to house or farm to farm. It may also present concerns about dual relationships, boundaries, and limits.

Volunteers can be a great asset to a program if properly trained and supervised.

People who wish to be of assistance to the outreach effort on a non-paid basis still need training and supervision. It is important that they understand the nature, scope, and limitations of the program and the means by which services can be delivered. There are dozens of ways outreach staff can use the assistance of volunteers in conducting community education, outreach to children, distributing materials, and other activities.

Both paid staff and volunteer staff should be screened through a formal process.

A careful screening, interview, and reference check process before accepting an individual as part of the program is critical. In rural communities word travels extremely fast. If the crisis counseling project has an outreach worker or volunteer that is inappropriate or a poor representative of the program, the community confidence in the program will plummet quickly.

Training and ongoing supervision are essential for everyone.

No matter who is hired, what their background or experience, they will need training and supervision to be a productive member of the crisis counseling project. Licensed clinicians and professionals require orientation to crisis counseling concepts, and therefore must be expected to receive the same training as paraprofessionals or non-licensed individuals (NIMH, 1983).

In addition, staff may benefit from specialized training that reflects the nature of the work in rural areas. Safety and security issues and cultural sensitivity training may be as important as basic disaster stress training. Some issues to consider are:

Cultural sensitivity regarding new or transient residents in the area. Small towns are sometimes attractive to groups of immigrants such as Laotian, Cambodian, Somalian, or Vietnamese. Migrant populations also pose cultural barriers or social nuances that can impact a worker's acceptance as a helper.

Special population groups may also inhabit rural areas. Crisis counseling workers should be briefed on any group of people who may pose a challenge or threat to them. Rural areas are popular with extremist groups, and are potential sites for production of illegal crops.

Crisis communication and conflict resolution skills are important in a rural setting because workers are often alone and may be in remote areas. Consideration should be given to providing training on self-defense strategies. Many police departments will provide training in defensive tactics for little or no fee. Every worker should know the emergency resources available (sheriff, emergency medical services, and crisis intervention services) in their region and have immediate access via cellular phones or two way radios.

Tips and techniques for managing a confrontation with an angry dog may help prepare workers to deal with a threatening situation. Further, consider the types of wildlife that may be encountered in a crisis counseling staff's travels. Training on identifying and managing situations in which workers may encounter dangerous wildlife such as poisonous snakes, alligators, moose, bears, or tics that produce Lyme Disease may help prevent injury.

"How to talk to farmers" may be helpful training for workers unfamiliar with the jargon regarding agricultural areas. A primer on hog farming, sugar beets, or peach orchards may help workers connect by speaking the same language. The university extension or agricultural service agencies in most States may be able to help with this type of training.

Staff Safety and Security

Staff safety and security is always a concern for crisis counseling projects. Concerns that have impacted rural crisis counseling projects are centered on three main areas:

• Workers becoming stranded
  
  
• Natural risks such as dogs, physical exhaustion, and illness
  
  
• The risk of personal harm from individuals due to anger, substance abuse, or other factors that increase the potential for violence

Workers Becoming Stranded

Outreach workers for past programs have worked alone and in pairs. Male/female teams have proven successful. Workers have reported a greater sense of security and less isolation by working in pairs. Also, disaster survivors were not as wary of a couple as they might be of two men. Female outreach workers felt safer working in a tandem with a male co-worker. Dual-gender teams allowed natural access to the husband/farmer and the wife/homemaker.

Traveling late in the day to early evening was a concern for some outreach workers, particularly in the winter when the weather is unpredictable. Providing cellular phones not only addressed safety concerns, but also improved communication with the office and survivors (Project Help Final Report, Wisconsin, 1994). In areas where a worker may be far from home at the end of a day of outreach, budgeting for some overnight lodging can decrease night driving, save time, and decrease wear-and-tear on the worker, as well as address safety issues.

Establishing specific times for workers to call into the office each day provided some programs a way to maintain contact with their workers. A routine opportunity to debrief by sharing concerns and feelings associated with the day-to-day aspects of the job also provided supervisory and administrative staff feedback on what might be done to improve the safety of the workers. It is also an important opportunity for the worker to connect with other staff and process their feelings.

Natural Risks

When an outreach worker gets out of the automobile at a farm house, there could very well be several dogs, not just one. Training on how to respond to agitated animals by a professional animal handler would be an unusual, but useful, addition to a program where these risks exist.

Other natural risks relate to the potential for injury, stress related ailments, and other health difficulties in outreach staff. Working long hours, exposure to the elements, and contact with large numbers of disaster survivors, can lower resistance to illness such as influenza. Crisis counseling staff tend to be very good at taking care of others but not as good at taking care of themselves. Rotating workers out of a disaster soon after the immediate impact is a way of avoiding burnout in disaster responders. Even over the longer term of the Regular Services project, rotating workers out of the disaster-affected area periodically can help reduce stress levels and provide a refreshing change of pace. In a rural setting, the isolation and overwork, rather than the overwhelming scenes of disaster impact, create problems.

Staff need to know that such periodic breaks from the intensity of their daily work is essential and required by supervisors. Such involvement both enhances their personal health and their ability to do good work. Injury is a risk due to the state of disrepair of many areas where rural outreach takes place. Debris and broken items in and around a home and ongoing construction projects constitute the greatest risks. Outreach workers should have a current tetanus shot (within ten years). The presence of foreign objects in roadways increases the potential for flat tires and automobile accidents. Training on how to reduce risks of personal injury can create a climate of safety consciousness and hopefully, reduce adverse incidents to workers during the program.

Risk of Harm from Others

By the very nature of the program, there is risk that an outreach worker will meet one or more individuals who are frustrated, angry, and stressed. Some rural residents have purposely isolated themselves from others and may not be receptive to a home visit. Some people even before the disaster are antisocial and intimidating. Still others may be self-medicating for stress with alcohol or other drugs, escalating their potential for violence. The potential of encountering these individuals is a concern for outreach worker safety.

Workers need to understand that they may seek the assistance of law enforcement any time they feel their physical safety is at risk. Since contact with such aid may not be readily available in the midst of the situation, workers need to know it is all right to leave at any point if their concern begins to rise. Personal safety training may be beneficial. Providing guidance on signs of agitation and emotional difficulty, along with non-physical techniques for a de-escalation of such circumstances, is very useful. As noted earlier, consider providing cellular phones for outreach workers.

Outreach staff should have a clear protocol of how to respond when in a physically threatening situation. They should carry the names and numbers of law enforcement and mental health crisis intervention programs that may be used in an emergency. Consult with local law enforcement authorities and crisis intervention programs.

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