ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
ROCKY MOUNTAIN REGION DISASTER MENTAL HEALTH NEWSLETTER
Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT
March 8, 2002
"The toughest thing about success is that you've got to keep on being a success."
- Irving Berlin
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ABNORMAL STRESS RESPONSE ASSOCIATED WITH NIGHT
EATING SYNDROME
Night eating syndrome, characterized by a lack of appetite during the day
and insomnia and increased appetite at night, may be caused by an abnormal
response to stress, new study findings show.
Reuters Health Information 2002
http://www.medscape.com/viewarticle/425584
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WORK AND MARITAL STRESSORS ASSOCIATED WITH
INCREASED RISK OF MORTALITY IN MEN
Chronic work and marital stressors increase the risk of all-cause and
cardiovascular disease mortality in men, according to a report in the
February 11th issue the Archives of Internal Medicine.
Reuters Health Information 2002
http://www.medscape.com/viewarticle/425478
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DEPRESSION THERAPY LESS EFFECTIVE FOR SOME PATIENTS
Elderly women, people with serious physical illness and less-educated
individuals may be less likely than others to have an improvement in
symptoms during treatment for depression, new research shows.
Reuters Health Information 2002
http://www.medscape.com/viewarticle/425157
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UNMARRIED CHILDLESS MEN RISK DEPRESSION WITH AGE.
Elderly unmarried men who are childless suffer significantly higher
rates of loneliness and depression than elderly unmarried women,
according to two Penn State researchers. "In our study, the lack of
biological children per se did not significantly increase the
incidence of loneliness and depression at advanced ages," says
Zhenmei Zhang, a doctoral student in sociology. "Marital status
rather than parental status is a more salient factor influencing
loneliness and depression in old age. Compared to women, men, on the
whole, have much smaller social support networks outside of the
immediate family, a circumstance that may be worsened by
childlessness combined with being unmarried." Zhang is the lead
author of a paper on the topic that appeared recently in the Journal
of Gerontology: Social Sciences. Her co-author is Mark D. Hayward,
professor of sociology and demography and director of the
University's Social Science Research Institute and the Population
Research Institute. For the full story by Paul Blaum, visit
http://www.psu.edu/ur/2002/elderlychildlessmen.html.
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SOME GUIDELINES FOR DISASTER MENTAL HEALTH WORKERS
WORKING WITH FAMILIES AND CHILDREN
Disaster work requires training, supervision and consultation with human service workers, many of whom have little or no
training in disaster issues. Professionals and paraprofessionals work side by side utilizing basic skills in responding to the
special needs of children and families who have experienced a disaster.
PROVIDING DISASTER MENTAL HEALTH SERVICES
The goal 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. Most disaster survivors do not perceive themselves as being ill or in need of mental health services. As a result, crisis
counseling programs emphasize outreach to communities, neighborhoods, churches, schools, and existing social networks in order
to help people who typically would not seek assistance from mental health service agencies. Hundreds of crisis counseling
programs across the country have demonstrated that paraprofessionals indigenous to the affected community perform very effectively
in the role of providing basic crisis counseling services. These programs have 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. However, they 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 kinds 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 possible about the community resources specifically offering services to
children. Some examples include family services agencies, child guidance agencies, child care centers, and after school programs.
Because of 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.
SUPERVISING HUMAN SERVICE WORKERS
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. Outreach workers
must have certain communication skills and other attributes necessary to successfully conduct their roles. These are
discussed in a number of CMHS publications. The following are some examples of the broad range of supervisory roles that 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.
MENTAL HEALTH TRAINING
Crisis Counseling Programs often engage mental health professionals to provide specific information about working with special
populations. Following a disaster, people 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 people 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 parties involved. Mental
health professionals may be called on to provide ongoing training on specific topics to crisis counseling staff. Some examples might
include: 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.
CONSULTING
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 in integrating 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 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 for
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.
HELPING CRISIS COUNSELING STAFF MANAGE STRESS
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 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
the worker often 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/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. Some examples of typical stress management activities linked to Crisis Counseling Programs include:
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 following 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 who are 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.
SUMMARY
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 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 during uncertain times may have a lasting effect on a child. Knowing the types of assistance available in a community is
necessary in responding to the needs of children following a disaster.
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REFERENCES
Aguilera, D.M. & Planchon, L.A. (1995). The American Psychological Association-
California Psychological Association disaster response project: Lessons learned
from the past, guidelines for the future. Professional Psychology: Research
and Practice, 26(6), 550-557.
American Academy of Child and Adolescent Psychiatry. (1998). Facts for families:
Helping children after a disaster [Fact Sheet No. 36]. Washington, DC: Author.
http://www.aacap.org/publications/factsfam/disaster.htm Retrieved February 27, 2002.
American Psychiatric Association. (1994). Diagnostic and statistical manual of
mental disorders (4th ec.). Washington, DC: Author.
American Red Cross. (1997). Emotional health issues for victims. Arlington, VA: Author.
http://www.redcross.org/disaster/safety Retrieved February 27, 2002.
Apetekar, L. & Boore, J.A. (1990). The emotional effects of disaster on children:
A review of the literature. International Journal of Mental Health, 19(2), 77-90.
Bowlby, J. (1982). Attachment and loss (Vol 1). London: The Hogarth Press.
DeWolfe, D.J. (2000). Training manual for disaster mental health workers (2nd Ed.).
Rockville, MD: Center for Mental Health Services.
Echterling, L.G. (1988). An ark of prevention: Preventing school absenteeism after
a flood. Journal of Primary Prevention, 8(4).
Flynn, B.W. & Nelson, M.E. (1998). Understanding the needs of children following
large-scale disasters and the role of government. Child and Adolescent Psychiatric
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Green, B.L., Korol, M., Grace, M., Vary, M.G., Leonard, A.C., Gleser, G.C. &
Smitson-Cohen, S. (1991). Children and disaster: Gender and parental effects on
PTSD symptoms. Journal of the American Academy of Child Psychiatry, 25, 346-356.
LaGreca, A.M. (1996). Symptoms of posttraumatic stress in children after Hurricane
Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64(4), 712-723.
LaGreca, A.M., Vernberg, E.M., Silverman, W.K., Vogel, A.L. & Prinstein, M.J. (1994).
Helping children prepare for and cope with natural disaster: A manual for professionals
working with elementary school children. Coral Gables, FL: The BellSouth Foundation & the
University of Miami.
Lystad, M. (1985). Special programs for children. Children Today, 14(1), 13-17.
Mitchell, J.T. & Everly, G.S., Jr. (1993). Critical incident stress debriefing (CISD): An
operations manual for the prevention of traumatic stress among emergency services
and disaster workers. Ellicott City, MD: Chevron.
O'Hara, D. (1994). Critical incident stress debriefing: Bereavement support in schools:
developing a role for an LEA educational psychology service. Educational Psychology
in Practice, 10, 27-34.
Pynoos, R.S., Steinberg, A.M. & Goenjian, A. (1996). Traumatic stress in childhood
and adolescence. In B.A. van der Kolk, A.C. McFarlane, & L. Weisaeth (Eds.) Traumatic
stress: The effects of overwhelming experience on mind, body, and society. New York:
The Guilford Press.
Saylor, C.F. (1988). Children and Disasters. New York, NY: Plenum Press.
Speir, A. H. (1999). Disaster response and recovery: A handbook for mental health
professionals (Draft Rev. Ed.). Rockville, MD: Center for Mental Health Services.
University of Illinois at Urbana-Champaign. (1998). Children, stress, and natural
disasters: School activities for children. Urbana-Champaign, IL: Author
http://www.ag.uiuc.edu/~disaster/teacher/teacher.html Retrieved February 27, 2002.
Yule, W. & Canterbury, R. (1994). The treatment of post traumatic stress disorder in
children and adolescents. International Review of Psychiatry, 6, 141-151.
Vernberg, E.M., LaGreca, A.M., Silverman, W.K. & Prinstein, M.J. (1996). Prediction
of posttraumatic stress symptoms in children after hurricane Andrew. Journal of Abnormal
Psychology, 105(2), 237-248.
Vogel, J. & Vernberg, E.M. (1993). Children's psychological response to disaster.
Journal of Clinical Child Psychology, 22, 470-484.
To search for books on disasters and disaster mental
health topics, children and disasters, schools and disasters,
crisis intervention, schools and crises, suicide, PTSD and
children, families and disaster and related topics and purchase
them online, go to the following url:
https://www.angelfire.com/biz/odochartaigh/searchbooks.html
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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.
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George W. Doherty
O'Dochartaigh Associates
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
