Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT July 27, 2001 "We always admire the other fellow more after we have tried to do his job." - William Feather LINKS AND SHORT TOPICS
LINKS AND SHORT TOPICS
SPECIAL EDUCATION PARTNERSHIP TO EXPAND NATIONWIDE
A Penn State program for special education teachers is expanding to provide continuing graduate education to states across the country. Since 1998, Penn State faculty have delivered courses in the Applied Behavior Analysis (ABA) program to more than 400 special education teachers, counselors, speech language pathologists and other professionals from Pennsylvania and the neighboring region. Through the use of distance education, the ABA program hopes to reach many hundreds more. The ABA program also serves as the foundation for Penn State's new Autism Specialist Program, a master's degree of the College of Education's Department of Special Education and the College of Health and Human Development's Department of Communication Disorders. The two-year program includes the ABA course sequence, specialized seminars and a family practicum that emphasizes the role of parents of autistic children. The newly launched autism program recently received $1.5 million in funding from the U.S. Office of Education. For the full story by Celena Kusch, visit http://www.outreach.psu.edu/news/.The ACISA 2001 Trauma Across Cultures Conference Program is now available on http://www.acisa.org.au/conference2001 The Conference will be held at the Carlton Crest Hotel in Brisbane 2 - 5 August. Post-Conference workshops will be at Warilda Conference Centre, Brisbane, on 6 August.
For further information please contact:
Sally Brown Conference Connections
PO Box 108 Kenmore QLD 4069
Telephone (61 7) 3201 2808
Facsimile (61 7) 3201 2809
E-mail: sally.brown@uq.net.auThe Red Cross Disaster Mental Health Services-I (DMHS-I) course will be offered in Casper, WY on Friday-Saturday, September 14-15, 2001. If you want to take this course as a Disaster Mental Health Professional, please send an email for further details on how to register to:
GeorgeDoherty@mail2consultant.com
The enrollment is limited to 20 participants. APA has approved this course for 12 CEUs. Other mental health professions have also approved it for continuing education.CRITICAL INCIDENT STRESS WORKSHOP sponsored by The University of Wyoming Counseling Center and The Rocky Mountain Disaster Mental Health Institute will be held in Laramie, WY on November 16, 17, 2001. There will be two workshops. One will be in Basic Critical Incident Stress Management (CISM) on 11/16-11/17 and will be a certification course taught by International Critical Incident Stress Foundation (ICISF) certified trainers. The Advanced Issues in Critical Incident Stress Debriefing will be taught by U.S. Navy Psychologist CDR Bryce Lefever, PhD, ABPP. Enrollment in both workshops is limited. There is an early bird registration period. If you wish to receive a printed brochure, please email GeorgeDoherty@mail2consultant.com with your name and mailing address. Online Brochure can be accessed at: https://www.angelfire.com/biz3/news/cismuw.html
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SOME GUIDELINES FOR CISD GROUP LEADERS
Critical Incident Stress Debriefing (CISD) is a simple but effective way to attenuate the stress reactions triggered by a disaster. It also makes it possible to attenuate, or even eliminate, the stress reactions that continue following the event. The literature on the subject suggests that Critical Incident Stress Debriefing sessions yield good results if they take place shortly after the disaster. Basic needs (lodging, clothing, food, etc.) must be met prior to holding these sessions. This is so that cognitive activities can make room for emotional release and examination of emotions. This type of intervention makes it possible to: * provide an opportunity, under appropriate conditions, for expressing emotions and avoiding repression and denial od symptoms; * normalize stress reactions through group discussions and exchanging of information; * reorient irrational and negative thoughts; * provide a mechanism for identifying p[ersons who may need further support services; and * provide people with information regarding services available to them in the community. Optimal Intervention Must: TAKE PLACE * as soon as possible following the appearance of symptoms (idea of "immediacy") * as near as possible to the site of the disaster or evacuation (idea of "proximity") BRING TOGETHER * similar groups (idea of "community") CREATE * a favorable atmosphere that promotes the following message: What people are experiencing is normal. They can recover and go back to normal lives. (idea of "expectancy") Timing For Group Debriefing Critical Incident Stress Debriefing (CISD) sessions can be held at anytime. However, the lapse of time between the event and when a session is held can have a significant influence on the behavior of individuals during the CISD session. Never: Within the 24 hours of the Incident Time is needed to allow one's psychological defense to drop. Only then can one deal with the underlying psychological impact of the incident. Defuse - don't debrief. Ideal: 24 to 72 hours after the Incident Individuals have had an opportunity to recover from the initial trauma and reflect on the incident either at a conscious or unconscious level. If one is going to deal with the pain, this is the opportune time - before suppression begins. Good: Within a Few Weeks of the Incident Suppression of the psychological aspects of the incident is still minimal and the psycho- educational process is still effective. Acceptable: Within 12 Weeks of the Incident Mitchel's experience with trauma incidents indicates that within this time most individuals are able to access the psychological issues in a constructive and non-therapeutic manner. The author's experience also indicates that certain individuals may not be able to respond appropriately, however, the group process should be manageable. Discouraged: 12 Weeks or Later By this time it is probable that the psychological impact of this event has been suppressed to the subconscious. As a result, individuals may react in a less than constructive fashion or require a more strategic debriefing performed on an individual basis. An EDUCATIONAL SESSION would be the intervention of choice. In this way, distressed individuals can still be advised of the signs and symptoms of critical incident stress, strategies for effective coping and stress management. As well, individual debriefings could be offered. PREPARATION * Leader The leader and his/her co-leader contact the people affected and meet with the appropriate person or the person responsible for the group to gain an overview of the situation and get some idea as to the intensity of the emotions being felt by the members of the group. * Composition of the Group To encourage exchanges, the composition of the group must be homogeneous. The characteristics of the participants must be taken into account: * Primary Clientele: persons who experienced the traumatic event directly. They are the survivors and the people who directly witnessed the disaster or tragedy; * Secondary Clientele: includes those persons who suffered the loss of someone close to them, who died at the time of the disaster or tragedy; and * Tertiary Clientele: includes operational personnel, the various coordinators and officials, the staff providing psychological support and the population. Who Should Be Included In A Debriefing Session? Any person associated with a traumatic event may participate in a debriefing session. Debrief Those In Greatest Need First. Picture a target with concentric circles. The closer you are to the center of the circle, the more directly or more closely involved you were with the incident. Set your priorities so that those closest to the center of the circle get debriefed first. In this way, you ensure your energies go to those in greatest need. You have only so much energy and so many resources. Use them wisely. Debrief Homogeneous Groups For debriefings to work, individuals need to feel safe. Debrief those who attended an incident or those who witnessed one separately from those who did not. Those who attended an incident often feel uncomfortable with those not directly involved with the incident present. As well, details forthcoming in a debriefing could unnecessarily traumatize those who were not in attendance. As well, when debriefing emergency service groups, ensure they are professional equals. The debriefing may not work if others not of similar occupational status are present. Number of Participants A group should ideally have no more than twelve participants (fewer if the event has taken a very heavy emotional toll on the participants). PRELIMINARY STEPS for the organization of CISD activities CLIENTELE Identify the group that has experienced or been affected by the event. INFORMATION TO BE COLLECTED Determine certain fears and reactions of specific group. For Example: * contact persons themselves or significant persons (spouse, friend, teacher, employer and so on) or key suppliers of information (mayor, priest or minister, recreational director, golden age club president, etc.); * listen to media news reports; and * obtain information from the people who alerted the local community services center. Has this group been influenced? For Example: * "The children arrive at school loaded down with adult worries. They've heard their parents talking at night." Are rumors or behaviors amplifying the group's reactions? For Example: * Is fear spreading throughout the community? Is the group made up of persons from different cultural communities? Could certain beliefs, traditions or customs be influencing some people's reactions and fears and their expression of what they are feeling? For Example: * Some cultural communities do not encourage expression of emotions. Sometimes you may find yourself with a silent group. GROUP HOMOGENEITY PRIORITY: Primary Clientele PARTNERS With whom should the debriefing sessions be organized? For Example: * Daycare teacher, school teacher, employee assistance program and so on. DEBRIEFING ACTIVITY Are the tools involved meaningful for the target clientele? PHYSICAL, NATERIAL ORGANIZATION Take into account the living environments of the specific groups. PUBLICITY Who do you want to reach and how will the groups be organized? For Example: * Registration of participants. STRUCTURE OF THE SESSION The leader and his/her co-leader should arrive at least 45 minutes prior to the debriefing session to make contact with the persons responsible for the group, receive further information, examine documents or reports on the event, and welcome the participants. The leader ensures that people are seated in a circle or around a table, and that each individual can see all the participants. The co-leader sits among the participants, in order to observe the reactions of those persons seated near the leader. The role of the co-leader is simply to be present and to provide support by speaking briefly or call attention to points that remain outstanding. He/she must accompany any individuals who leave the session because of the emotions they are experiencing. It is important that boxes of tissues be available for participants who might need them when they are recounting or experiencing moments of intense emotion. Develop special sheets to help the leader during the debriefing session. The leader ensures that the rules governing debriefing sessions are followed. A FEW INSTRUCTIONS Freedom to speak Anyone is free not to speak if he/she so wishes, but everyone should be encouraged to do so. Speaking about oneself People may speak only about themselves; hearsay is not allowed. Respect for others Do not relate details that could embarrass other participants. Equality During the session, there is no seniority. All are to participate as equals. Psycho-education rather than therapy The session is not intended to provide therapy. Rather, it is intended to help the participants return to normal and find their equilibrium as soon as possible. Respect for cultural aspect The cultural characteristics of the group must be taken into account. Some traditions, beliefs and customs may influence the expression of emotions. Expressing oneself during session The people working with the group involved are usually available after the session, if necessary, but the participants are strongly encouraged to express themselves during the session. Directly associated with event Only people who were directly affected by the event or who witnessed it directly should participate in the debriefing session. Special needs Smokers are allowed to smoke, as long as this does not bother the other participants. No interruptions Pagers (including those of the leaders) must be turned off. Respect for privacy The taking of notes, the making of sound recordings and the presence of the media are strictly prohibited. Pay attention to people who remain silent Attention must be paid to people who do not speak, but who seem upset. They can be approached later one-on-one if it is found that they were reluctant to express themselves in front of a group. No late arrivals, no early departures If the members of the group are to feel confident and secure, they must all be present from start to finish. No black humor After a traumatic event, humor is not effective. Rather, it can cause strong negative reactions. No breaks If people are to move from objective facts to emotional reactions, the process must be continuous. Confidentiality Confidentiality should be maintained. ATMOSPHERE The meeting must take place in a favorable atmosphere of support and understanding. The reactions of the various individuals are pooled and accepted. The basic rule is that no one may criticize anyone else. All kinds of problems can arise during debriefing sessions. Here are a few, along with some suggestions as to how to deal with them. People who want to leave Remind them that all that is being asked of them is that they tell us what they witnessed. Add that what they have to say could be very useful to the others. If someone does leave, ask the co-leader to speak to that person, encourage him/her to stay, and, if the person does not wish to remain, tell him/her how to reach us later. Overly talkative people Take advantage of a pause to thank the person for participating and ask clearly: "Does anyone else have something to add here?" If several people talk too much, as clearly: "Is there anyone who has not had an opportunity to state an opinion regarding this aspect of the event and who would like to speak now?" People who are deeply affected Allow them to express their feelings. Offer facial tissues. Do not intrude on their privacy, but offer symbolic support. Touch base with them at the end of the session and ensure that they are all right. Someone who cries and leaves Ask the co-leader to follow the person. If appropriate, propose that the person walk around a bit. Encourage him/her to come back. If the person does not wish to return, offer him/her support outside the group. Ensure that the session leader discusses the matter if the person does not return. Blamers Thank them for being concerned about the issue and focusing on the problem. Remind them that, for the time being, the idea is for everyone to speak about what they experienced when the event occurred. Ask them how they themselves experienced the problem...without analyzing the cause or responsibility. People who give advice Thank them for their comments and redirect the group's attention. Discussions regarding previous traumatic events If such discussions go on very long, explain that it is perfectly normal to remember a previous incident, and bring the group's attention back to the actual event. People who remain silent Keep an eye on them and make contact with them at the end of the session. Group membership problems Do the best you can to make sure that the composition of the group is appropriate before the session begins. If the group includes people who should not be there, take them aside and redirect them (individual session if appropriate). If this occurs at the start of the session, take the necessary time and deal with the matter. Do not try to lead a group whose composition is not right; the session will be ruined. AT THE END OF THE DEBRIEFING The leader states that he/she and the co-leader will be available following the meeting if the participants have anything to discuss. The leader informs the participants that they will be contacted again in two to four weeks to be asked how things are going.********************************************************************************************** To search for books on disasters and disaster mental health topics and purchase them online, go to the following url: https://www.angelfire.com/biz/odochartaigh/searchbooks.html ********************************************************************************************** *********************************************************************************************** Contact your local Mental Health Center or check the yellow pages for counselors, psychologists, therapists, and other Mental health Professionals in your area for further information. ***************************************************************************************** George W. Doherty O'Dochartaigh Associates Box 786 Laramie, WY 82073-0786 MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
