Disaster Response Chaplaincy

Bukal Life Care & Counseling Center2013

Goal

To prepare chaplains, clergy, and laypersons for providing crisis stress defusing and debriefing ministry interventions during disasters.

This is an overview... a starting point for crisis response.

What is a Disaster?

Sudden and/or unexpected event Affects a number of people, a community,

or multiple communities. Element of danger to those affected...

particularly injury or loss of human life. Involves economic loss... particularly to

property.

Key Points

1. What separates Disaster from Inconvenience is PERCEPTION of those affected. They are the judge, not the care provider.

2. The care provider's role is NOT to return things “back to normal.” Rather, the role is to help those affected come to an acceptable and healthy “new normal.”

NOVA Key Purposes of Providing Crisis Intervention

Educate people about common crisis reactions

Provide professional and peer validation

Defuse the emotional overload caused by crisis reactions

Provide focus on how people can begin to cope positively with the chaos

Help assess whether people need referrals

Provide method whereby people can begin to organize their thoughts

NOVA Key Purposes of Providing Crisis Intervention

Help individuals begin to address what they are experiencing now and might experience in the future

Help victims and survivors begin to think about what provides meaning in their lives

Provide affirmation that many confusing reactions are not uncommon or abnormal

Reassure survivors that most people can cope well and encourage them to build on strengths and adaptive capacities for coping

Types of Disasters

Natural Disasters Man-Made Disasters Disasters that have both natural and man-

made elements.

This matters, because people ultimately will deal with “who to blame.” Self? Neighbor? Outsider? Government? God?

Some Things that Commonly Occur with Disasters

Extensive property damage and financial loss

Massive loss of life or displacement of humans and animals

Breakdown of transportation and access. Interruption of communication and public

utilities. Social break-down and political confusion

Post-Disaster Needs

Two Basic Phases: Relief. Immediate repair and clean-up

needs. Immediate basic survival needs. Development. Rebuilding of houses and

community infastructure. Rebuilding businesses and job development.

Failure to address the Development needs can perpetuate poverty and dependency

Crisis Care Team

Don't Self-deploy. Come by invitation. Be part of a recognized crisis intervention

team. Know who is in charge on site, and follow

their direction, and get their permission.

<Review Disaster Response Volunteer Guidelines>

Who are the Victims of Disasters?

Direct Victims: Living in the area of destruction.

Indirect Victims: Living on the fringes of the area of destruction. Inconvenienced but perhaps not devastated.

Hidden Victims: Family and friends of victims. Also, disaster volunteers, chaplains, professional caregivers.

Types of Victims

Classically, one does Critical Incident Stress Debriefing, CISD, for disaster response workers (hidden victims).

For other victims (especially direct victims), various methods of stress defusing are used (where focus is more on the now and future than reliving the past).

Prioritization of Care

As a Chaplain or Religious Care Provider, what needs to be dealt with first?

For purposes of disaster response, we follow the principles in Maslow's Hierarchy of Needs.

It is often shown as a pyramid with the idea that the lower needs on the pyramid must be met before higher needs can be dealt with.

Maslow's Hierarchy of Needs

Hierarchy of Needs

The most foundational is Basic or Physiological Needs: Air, water, food, shelter, sleep, body temperature regulation, emergent medical care, etc.

These must be dealt with at least to some extent before safety and security can be dealt with.

<Clarification: Removing the person from REAL physical danger, is a Basic, not

Safety, Need.>

Hierarchy of Needs

After basic needs are dealt with, one can focus on Safety and Security.

Primarily, this is Subjective. The goal is for the individual or group to FEEL safe, secure, stable, and free from anxiety and fear.

Hierarchy of Needs

The next level is Social Needs. This involves the need for belongingness and affection.

After the disaster, there is a need to reestablish healthy relationships, and give and receive affection.

This is vital for individuals, families, and communities as they develop towards a “new normal.”

Hierarchy of Needs

The higher level needs are Esteem (including a sense of competence and confidence) and Self-actualization (reaching the potential God has given the person, in the context he or she lives).

These primarily would be dealt with in the Development phase of disaster response rather than Relief phase.

Stress and Trauma Response

Stress is: “The non-specific response of the

body to any demand made upon it.”

-Hans Selye

Stress sometimes gets divided into “eustress” (healthy stress that keeps us learning and growing), and “distress” (unhealthy stress that is prolonged or excessive)

Trauma

Trauma is “an event outside the usual realm of human experience that would be markedly distressing to anyone who experienced it.” The event may be personal or vicarious, exposure to human suffering. -Mitchell and Bray

Trauma produces Distress

Trauma Response

Stress prepares our body for “flight or flight” response. This can be useful and even necessary to function briefly at peak efficiency. Distress, due to trauma or a pile-up of smaller stressors, can have very negative results in multiple ways.

Review Stress Chart (Handout)

Three Common Signs a Person is Suffering from Trauma

1. Reexperiencing the Traumatic Event. Have trouble concentrating as they relive or dream the event.

2. Avoiding Memories of a Trauma. Avoid anything that reminds one of the trauma. Avoid talking about the trauma. Become more socially withdrawn.

3. Being constantly anxious and/or easily agitated.

Three Common Signs a Person is Suffering from Trauma

Dealing with one who is suffering from trauma is “Stress Defusing.” This involves a reduction of anxiety (item 3) through dialogue with a counselor, allowing victims to share as much of their story as they they feel comfortable (item 2), while not pushing them to relive that experience in their mind (item 1).

Doing this involves “Story-Listening.”

The Art of Story-Listening

-Listen – assimilate and integrate to make meaning of words

-Provide a sense of privacy

-Maintain confidentiality

-Be present in body and spirit

-Be silent sometimes

-Use reflective empathetic listening

-Respect their story... it is their own.

Review Handout on Therapeutic Communication

Crisis Invention Models

It is not recommended to simply “wing-it” or go into a counseling session with no plan.

Some models/orgs include:

-CISD (Critical Incident Stress Debriefing)

-NOVA (National Organization of Victim Assistance)

-PFA (Psychological First Aid)

-OSFA (Operational Stress First Aid)

CISD

Critical Incident Stress Debriefing is commonly used. It is quite structured. It was developed to do debriefing with first responders (caregivers).

As such, it is not really recommended for use with direct and indirect victims.

PFA/NOVA/OSFA

Each of these have their own strengths and weaknesses for direct and indirect victims.

We are going to focus on a Modified version of the stress defusing developed by NOVA.

The modification reduces the risk of retraumatization--- re-living the event.

However, the following 5-Cs of OSFA can be useful, so they will be described on the following slides.

5 C's of Survivor Recovery (OSFA)

Cover

Calm

Connect

Competence

Confidence

-www.usfa.fema.gov

5 C's

Cover: Help people regain a sense of safety after a traumatic event. May involve moving them to a safer place, protecting them from onlookers, or just letting them know you are there to help.

Calm: Calm victims by being calm oneself, showing understanding of the situation, and coaching on how to become calm.

-www.usfa.fema.gov

5 C's

Connect: Help people connect to family, pets, friends, social support structure.

Competence: Help them help themselves. Assist them to connect with social services and resources for self-care.

Confidence: Help them gain a hopeful sense of the future, reducing guilt and self-blame.

-www.usfa.fema.gov

NOVA

2 Forms: -Group Crisis Intervention (GCI)

-One on One Intervention

Basic Model

-Safety and Security (past)

-Validation and Ventilation (present)

-Prediction and Preparation (future)

<Note: allow victims to share their stories as they see them... don't pressure them to “relive” experiences.>

Elijah and Crisis Care

The story Elijah is instructive. In I Kings 19, Elijah was physically exhausted after a great battle of faith and endurance. Prepared to be declared victor, he finds that the battle is far from over and must run for his life to avoid certain death.

This is a clasic crisis. Elijah felt that there was no one he coud turn to except God. So he starts running to escape from his persecutors, and to “find God.”

Read I Kings 19:1-18

Safety and Security. Verses 3-9a. Elijah flees to a place of physical safety (away from his persecutors), emotional safety (a cave with no one else around), and spiritual security (in Mount Sinai... the “mountain of God”).

God gave him food and drink and encouraged him to rest so Elijah could go where he felt safe and secure, but otherwise did not interfere, blame, or correct.

Read I Kings 19:1-18

Ventilation and Validation. Verses 9b-14

God asks Elijah what he is doing here, inviting Elijah to “tell his story.” God does not challenge or condemn what Elijah said.

God demonstrates His power to Elijah but relates to him with a comforting voice in the cave.

Read I Kings 19:1-18

Prediction and Preparation. Verses 15-18

God gives Elijah new tasks... no more battles. He gives him a helper who will become his successor.

Only after giving Elijah a “new normal” and help for his future, does God correct a mistaken view... his view of being the only one faithful to God. There are others... Elijah's work was not fruitless and he is not alone.

Review and Practice NOVA “Cheat Sheet”

What about Children and Those with Special Needs

Some people need special care. This presentation cannot cover all circumstances. But here are some thoughts regarding children who have suffered through a disaster.

<Other groups requiring specialization include the very aged, and those with physical or mental disabilities.>

Myths about Children and Disaster

Myth #1: Children are better off not knowing. Children will create answers if not given answers. They need to know the truth, but the presentation and scope of the truth should be age appropriate.

Myth #2: Children forget bad events easily. Simply not true... most adults remember bad things from their childhood quite vividly.

Myths about Children and Disaster

Myth #3: Boys should not express sadness. Both boys and girls need to be able to express the feelings they are having. However, neither should be pressured to express feelings before they are ready... or only in specific prescribed ways.

Myth #4: Living through difficult times makes you stronger. Questionable. Difficult times may demonstrate preexisting inner strength that was not known before.

Working with Children

Dealing with crisis with children depends on age. But some activities can be done that help instill a sense of SAFETY, PREDICTABILITY, and CONTROL.

Some things include: Relaxation exercises and art activities. Additionally, use activities where the child starts focusing on what they have and what hope there is in the future.

Compassion in Crisis

Demonstrating compassion is being present in the suffering, sensitive to human diversity, providing the ministry of care in crisis.

Demonstrating compassion involves giving the gift of your undivided attention while TRYING to understand what they have been through.

Concern: Compassion fatigue (from burnout and secondary trauma)

“Red Flags” in Crisis InterventionTRYING TO DO TOO MUCH

Trying to “wing it” with no specific intervention plan

Trying to convert victims (a crisis is a poor time psychologically for a major change and an informed change)

Trying to debate theological issues with traumatized victims or survivors

Trying to meet spiritual needs without listening to the physical, emotional, and/or social needs

Trying to answer “why?” questions

“Red Flags” in Crisis InterventionETHICS/BOUNDARY ISSUES

Guard what has be entrusted to you... Maintain confidentiality

Respect victim vulnerability. Do not probe too deep.

Guard personal standards. Don't share much of your own Personal Information

Don't help TOO much (Decide on your limits). Don't flirt or have “Dual Relationships” Don't lie (Instead, give “truth with hope”)

What Victims Want to Tell Disaster Chaplains

Don’t explain Don’t try to take away my

pain Stay close to me Remember me when everyone

else has gone back to their normal routines

What Victims Want to Tell Disaster Chaplains

Listen to my doubts Don’t be afraid of my anger Be patient with me Remind me that this isn’t

all there is to life

References

“Crisis Care Chaplain Training Manual.” Virginia Baptist Mission Board, 2007.

“Helping Child Survivors of Disasters: A Practical Guide for Caregivers.” IBM, Corporate Citizenship & Corporate Affairs, 2008.

“Crisis Response Stress Defusing Handy Reminders.” National Organization of Victim Assistance.

“Divine Intervention: The Flight of Elijah in Dialogue with Crisis Care” by R. Munson, Bukal Life Care Journal, 2012.

www.usfa.fema.gov