Inside Front Cover -- Precedes Title Page

This publication was produced under an interagency agree-ment between the Federal Emergency Management Agencyand the Center for Mental Health Services, Substance Abuseand Mental Health Services Administration. Portland Ridleyserved as CMHS publications and editorial coordinator.

Copies are available at no charge from the Center for MentalHealth Services:

National Mental Health Services Knowledge ExchangeNetwork

P.O. Box 42490Washington, D.C. 20015

Toll-Free Information Line 1-800-789-2647CMHS Electronic Bulletin Board 1-800-790-2647TTY 301-443-9006FAX 301-984-8796Website www.mentalhealth.org

All material appearing in this volume, except quoted passages fromcopyright sources, is in the public domain and may be produced orcopied without the permission from the Administration or the authors.Citation of the source is appreciated.

DHHS Publication No. ADM 90-537Substance Abuse and Mental Health Services AdministrationPrinted 2000

i

Field ManualFOR MENTAL HEALTH AND

HUMAN SERVICE WORKERSIN MAJOR DISASTERS

Title page

Author

Deborah J. DeWolfe, Ph.D., M.S.P.H.

Editor

Diana Nordboe, M.Ed.

iii

INTRODUCTION .............................................................. v

KEY CONCEPTS OF DISASTER MENTAL HEALTH .................. 1

SURVIVORS’ NEEDS AND REACTIONS ................................ 5

DISASTER COUNSELING SKILLS ......................................... 7

Establishing Rapport .................................................. 7

Active Listening ......................................................... 7

Some Do’s and Don’t’s .............................................. 8

Problem-Solving ........................................................ 9

A Word of Caution .................................................... 11

Confidentiality .......................................................... 12

WHEN TO REFER FOR MENTAL HEALTH SERVICES ............... 13

POTENTIAL RISK GROUPS ................................................ 15

Age Groups ............................................................... 15

Cultural and Ethnic Groups ....................................... 21

People With Serious and Persistent Mental Illness ..... 21

People in Group Facilities ......................................... 22

Human Service and Disaster Relief Workers ............. 23

Table of Contents

TABLE OF CONTENTS

iv Table of Contents

STRESS PREVENTION AND MANAGEMENT .......................... 25

Organizational Approaches ....................................... 26

Individual Approaches............................................... 28

v

This Field Manual is intended for mental health workersand other human service providers who assist survivors

following a disaster. This pocket reference provides thebasics of disaster mental health, with numerous specific andpractical suggestions for workers.

Essential information about disaster survivors’ reactionsand needs is included. “Helping” skills are described withguidance for when to refer for professional assistance.Strategies for worker stress prevention and management arepresented in the last section.

The Field Manual condenses and focuses material con-tained in the Training Manual for Mental Health and HumanService Workers in Major Disasters, second edition (Publi-cation No. ADM 90-538). Separate publications on chil-dren, older adults, people with serious and persistentmental illness, rural communities following disasters, anddisaster mental health services are available through theCenter for Mental Health Services.

INTRODUCTION

Introduction

1

The following principles guide the provision of mentalhealth assistance following disasters. The truth and

wisdom reflected in these principles have been shown overand over again, from disaster to disaster.

KEY CONCEPTS

No one who sees a disaster is untouched by it.

There are two types of disaster trauma—individual andcommunity.

Most people pull together and function during and aftera disaster, but their effectiveness is diminished.

Disaster stress and grief reactions are normal responsesto an abnormal situation.

Many emotional reactions of disaster survivors stemfrom problems of living brought about by the disaster.

Most people do not see themselves as needing mentalhealth services following disaster and will not seeksuch services.

Survivors may reject disaster assistance of all types.

Disaster mental health assistance is often more practi-cal than psychological in nature.

Key Concepts of Disaster Mental Health

KEY CONCEPTS OFDISASTER MENTAL HEALTH

2 Key Concepts of Disaster Mental Health

Disaster mental health services must be uniquelytailored to the communities they serve.

Mental health workers need to set aside traditionalmethods, avoid the use of mental health labels, and usean active outreach approach to intervene successfullyin disaster.

Survivors respond to active, genuine interest, andconcern.

Interventions must be appropriate to the phase of thedisaster.

Social support systems are crucial to recovery.

Most people who are coping with the aftermath of adisaster are normal, well-functioning people who arestruggling with the disruption and loss caused by the disas-ter. They do not see themselves as needing mental healthservices and are unlikely to request them. This is whydisaster mental health workers must go to the survivors andnot wait and expect that survivors will come to them.Survivors often find terms like “assistance with resources”and “talking about disaster stress” to be acceptable, andservices described as “psychological counseling” and“mental health services” to be for someone else.

Going to survivors means using community outreachstrategies. Soon after the disaster, survivors gather in shel-ters, at mass feeding sites, at disaster recovery centers, atdisaster information meetings, and in their neighborhoodsto clean up and repair their homes. Churches, senior

3Key Concepts of Disaster Mental Health

centers, local cafes, schools, and community centers arealso likely locations where survivors congregate. A consider-able amount of psychological support can occur informallyover a cup of coffee.

Most importantly, survivors respond to genuine concern,a listening ear, and help with immediate problem-solving.Survivors find brochures and information about “normalreactions to disaster stress” and “how to cope” to be ex-tremely helpful. Disaster mental health services mustactively fit the disaster-affected community. This meansworkers are culturally sensitive, provide information in thelanguages spoken, and work with local, trusted organiza-tions, and community leaders to better understand survi-vors’ needs.

5

Floods, tornadoes, hurricanes, earthquakes, hazardousmaterials accidents, terrorist acts, and transportation

accidents cause many similar and predictable reactions.While there may be specific disaster-related stressors,underlying concerns and needs are consistent. These are:

A concern for basic survival

Grief over loss of loved ones and loss of valued andmeaningful possessions

Fear and anxiety about personal safety and the physicalsafety of loved ones

Sleep disturbances, often including nightmares andimagery from the disaster

Concerns about relocation and the related isolation orcrowded living conditions

A need to talk about events and feelings associatedwith the disaster, often repeatedly

A need to feel one is a part of the community and itsrecovery efforts

In the days and weeks after a disaster, the most commontypes of problems encountered are problems in living. Thesemight include transportation problems, unemployment, loss

Survivors’ Needs and Reactions

SURVIVORS’ NEEDSAND REACTIONS

6 Survivors’ Needs and Reactions

of child care, inadequate temporary accommodations,inability to locate a missing loved one, filling prescriptions,lost eyeglasses, difficulty applying for disaster relief loans,or public health concerns. Disaster workers often find thatas they assist a survivor with the immediate problems athand, they earn the survivor’s trust and are told about his orher unique struggles and emotions.

7Disaster Counseling Skills

Disaster counseling involves both listening and guiding.Survivors typically benefit from both talking about

their disaster experiences and being assisted with problem-solving and referral to resources. The following sectionprovides “nuts-and-bolts” suggestions for workers.

ESTABLISHING RAPPORT

Survivors respond when workers offer caring eye contact,a calm presence, and are able to listen with their hearts.Rapport refers to the feelings of interest and understandingthat develop when genuine concern is shown. Conveyingrespect and being nonjudgmental are necessary ingredientsfor building rapport.

ACTIVE LISTENING

Workers listen most effectively when they take in infor-mation through their ears, eyes, and “extrasensory radar” tobetter understand the survivor’s situation and needs. Sometips for listening are:

Allow silence – Silence gives the survivor time to reflectand become aware of feelings. Silence can prompt thesurvivor to elaborate. Simply “being with” the survivorand their experience is supportive.

DISASTER COUNSELINGSKILLS

8

Attend nonverbally – Eye contact, head nodding, caringfacial expressions, and occasional “uh-huhs” let thesurvivor know that the worker is in tune with them.

Paraphrase – When the worker repeats portions of whatthe survivor has said, understanding, interest, andempathy are conveyed. Paraphrasing also checks foraccuracy, clarifies misunderstandings, and lets thesurvivor know that he or she is being heard. Good lead-ins are: “So you are saying that . . . “ or “I have heardyou say that . . . ”

Reflect feelings – The worker may notice that thesurvivor’s tone of voice or nonverbal gestures suggestsanger, sadness, or fear. Possible responses are, “Yousound angry, scared etc., does that fit for you?” Thishelps the survivor identify and articulate his or heremotions.

Allow expression of emotions – Expressing intenseemotions through tears or angry venting is an importantpart of healing; it often helps the survivor work throughfeelings so that he or she can better engage in construc-tive problem-solving. Workers should stay relaxed,breathe, and let the survivor know that it is OK to feel.

SOME DO’S AND DON’T’S

Do say:

✓ These are normal reactions to a disaster.

✓ It is understandable that you feel this way.

Disaster Counseling Skills

9

✓ You are not going crazy.

✓ It wasn’t your fault, you did the best you could.

✓ Things may never be the same, but they will get better,and you will feel better.

Don’t say:

✕ It could have been worse.

✕ You can always get another pet/car/house.

✕ It’s best if you just stay busy.

✕ I know just how you feel.

✕ You need to get on with your life.

The human desire to try to fix the survivor’s painfulsituation or make the survivor feel better often underlies thepreceding “Don’t say” list. However, as a result of receivingcomments such as these, the survivor may feel discounted,not understood, or more alone. It is best when workersallow survivors their own experiences, feelings, and per-spectives.

PROBLEM-SOLVING

Disaster stress often causes disorganized thinking anddifficulty with planning. Some survivors react by feelingoverwhelmed and become either immobilized orunproductively overactive. Workers can guide survivors

Disaster Counseling Skills

10 Disaster Counseling Skills

through the following problem-solving steps to assist withprioritizing and focusing action.

ØØ ØØ Ø Identify and define the problem

Describe the problems/challenges you are facing rightnow.

Selecting one problem is helpful, identify it as the mostimmediate, and focus on it first. The problem should berelatively solvable, as an immediate success is importantin bringing back a sense of control and confidence.

ØØ ØØ Ø Assess the survivor’s functioning and coping

How have you coped with stressful life events in the past?

How are you doing now?

Through observation, asking questions, and reviewingthe magnitude of the survivor’s problems and losses, theworker develops an impression of the survivor’s capacityto address current challenges. Based on this assess-ment—the worker may make referrals, point out copingstrengths, and facilitate the survivor’s engagement withsocial supports. The worker may also seek consultationfrom medical, psychological, psychiatric, or disasterrelief resources.

11Disaster Counseling Skills

ØØ ØØ Ø Evaluate available resources

Who might be able to help you with this problem?

What resources/options might help?

Explore existing sources of assistance and support suchas immediate and extended family, friends, churchcommunity, health care providers, etc. and how thesurvivor might obtain their help. Refer the survivor to theappropriate relief agencies and assess if the survivor isable to make the calls and complete the requiredapplications. Assist with accessing resources whennecessary.

ØØ ØØ Ø Develop and implement a plan

What steps will you take to address this problem?

Encourage the survivor to say aloud what he or she plansto do and how. Offer to check-in with the survivor in afew days to see how it is going. If the worker has agreedto perform a task for the survivor, it is very important tofollow through. Workers should promise only what theycan do, not what they would like to do.

A WORD OF CAUTION

When confronted with a disaster survivor’s seeminglyoverwhelming needs, workers can feel the understandableimpulse to help in every way possible. Workers may be-come over involved and do too much for the survivor. This is

12

usually not in the best interest of the survivor. When survi-vors are empowered to solve their own problems, they feelmore capable, competent, and able to tackle the nextchallenge. Workers should clearly understand the scope oftheir role in the disaster relief effort and recognize thatempowering survivors is different from doing for them.

CONFIDENTIALITY

A helping person is in a privileged position. Helping asurvivor in need infers a sharing of problems, concerns, andanxieties—sometimes with intimate details. This specialsharing cannot be done without a sense of trust, built uponmutual respect, and the explicit understanding that alldiscussions are confidential and private. No case should bediscussed elsewhere without the consent of the personbeing helped (except in an extreme emergency when it isjudged that the person will harm himself or others). It isonly by maintaining the trust and respect of the survivor thatthe privilege of helping can continue to be exercised.

Disaster Counseling Skills

13

Referrals to mental health and other health care profes-sionals are made as workers encounter survivors with

severe disaster reactions or complicating conditions. Thefollowing reactions, behaviors, and symptoms signal a needfor the worker to consult with the appropriate professionaland, in most cases, to sensitively refer the survivor forfurther assistance.

Disorientation – dazed, memory loss, inability to givedate or time, state where he or she is, recall events ofthe past 24 hours or understand what is happening

Depression – pervasive feelings of hopelessness anddespair, unshakable feelings of worthlessness andinadequacy, withdrawal from others, inability to engagein productive activity

Anxiety – constantly on edge, restless, agitated, inabil-ity to sleep, frequent frightening nightmares, flashbacksand intrusive thoughts, obsessive fears of anotherdisaster, excessive ruminations about the disaster

Mental Illness – hearing voices, seeing visions, delu-sional thinking, excessive preoccupation with an ideaor thought, pronounced pressure of speech (e.g., talkingrapidly with limited content continuity)

When to Refer for Mental Health Services

WHEN TO REFER FORMENTAL HEALTH SERVICES

14 When to Refer for Mental Health Services

Inability to care for self – not eating, bathing or chang-ing clothes, inability to manage activities of daily living

Suicidal or homicidal thoughts or plans

Problematic use of alcohol or drugs

Domestic violence, child abuse, or elder abuse

15

Each disaster-affected community has its own demographic composition, prior experience with disasters or

other traumatic events, rural or urban setting, and culturalrepresentation. Consideration should be given to the follow-ing groups, as well as additional groups with particularneeds residing in the disaster-affected area:

Age Groups

Cultural and Ethnic Groups

People with Serious and Persistent Mental Illness

People in Group Facilities

Human Service and Disaster Relief Workers

AGE GROUPS

Each age group is vulnerable in unique ways to thestresses of disaster. Different issues and concerns becomerelevant during the progression of phases in the post-disaster period. Some disaster stress reactions listed belowmay be experienced immediately, while others may appearmonths later. The following table describes possible disasterreactions of the different age groups and helpful responsesto them.

POTENTIAL RISKGROUPS

Potential Risk Groups

16Potential R

isk Groups

Disaster Reactions and Intervention Suggestions

Ages BehavioralSymptoms

PhysicalSymptoms

EmotionalSymptoms Intervention Options

1-5 - Resumption ofbed-wetting,thumb sucking,clinging to parents

- Fears of the dark

- Avoidance ofsleeping alone

- Increased crying

- Loss of appetite

- Stomach aches

- Nausea

- Sleep problems,nightmares

- Speech difficulties

- Tics

- Anxiety

- Fear

- Irritability

- Angry outbursts

- Sadness

- Withdrawal

- Give verbal assurance and physicalcomfort

- Provide comforting bedtime routines

- Avoid unnecessary separations

- Permit the child to sleep in parents’room temporarily

- Encourage expression regardinglosses (i.e., deaths, pets, toys)

- Monitor media exposure to disastertrauma

- Encourage expression through playactivities

17Potential R

isk Groups

Ages BehavioralSymptoms

PhysicalSymptoms

EmotionalSymptoms Intervention Options

Disaster Reactions and InterventionSuggestions (Continued)

6-11 - Decline in schoolperformance

- Aggressivebehavior at homeor school

- Hyperactive or sillybehavior

- Whining, clinging,acting like ayounger child

- Increasedcompetition withyounger siblingsfor parents’attention

- Change in appetite

- Headaches- Stomach aches

- Sleep distur-bances, night-mares

- School avoidance

- Withdrawal fromfriends, familiaractivities

- Angry outbursts

- Obsessivepreoccupationwith disaster,safety

- Give additional attention andconsideration

- Relax expectations of performance athome and at school temporarily

- Set gentle but firm limits for actingout behavior

- Provide structured but undemandinghome chores and rehabilitationactivities

- Encourage verbal and play expres-sion of thoughts and feelings

- Listen to the child’s repeatedretelling of a disaster event

- Involve the child in preparation offamily emergency kit, home drills

- Rehearse safety measures for futuredisasters

- Coordinate school disaster programfor peer support, expressive activities,education on disasters, preparednessplanning, identifying at-risk children

18Potential R

isk Groups

Ages BehavioralSymptoms

PhysicalSymptoms

EmotionalSymptoms Intervention Options

Disaster Reactions and InterventionSuggestions (Continued)

12-18 - Decline inacademicperformance

- Rebellion at homeor school

- Decline inprevious respon-sible behavior

- Agitation ordecrease in energylevel, apathy

- Delinquentbehavior

- Social withdrawal

- Appetite changes

- Headaches- Gastrointestinal

problems

- Skin eruptions- Complaints of

vague aches andpains

- Sleep disorders

- Loss of interest inpeer socialactivities, hobbies,recreation

- Sadness ordepression

- Resistance toauthority

- Feelings ofinadequacy andhelplessness

- Give additional attention andconsideration

- Relax expectations of performance athome and school temporarily

- Encourage discussion of disasterexperiences with peers, significantadults

- Avoid insistence on discussion offeelings with parents

- Encourage physical activities

- Rehearse family safety measures forfuture disasters

- Encourage resumption of socialactivities, athletics, clubs etc.

- Encourage participation in commu-nity rehabilitation and reclamationwork

- Coordinate school programs for peersupport and debriefing, prepared-ness planning, volunteer communityrecovery, identifying at-risk teens

19Potential R

isk Groups

Ages BehavioralSymptoms

PhysicalSymptoms

EmotionalSymptoms Intervention Options

Disaster Reactions and InterventionSuggestions (Continued)

ADULTS - Sleep problems

- Avoidance ofreminders

- Excessive activitylevel

- Crying easily

- Increased conflictswith family

- Hypervigilance

- Isolation,withdrawal

- Fatigue, exhaus-tion

- Gastrointestinaldistress

- Appetite change

- Somatic com-plaints

- Worsening ofchronic conditions

- Depression,sadness

- Irritability, anger

- Anxiety, fear

- Despair, hopeless-ness

- Guilt, self doubt

- Mood swings

- Provide supportive listening andopportunity to talk in detail aboutdisaster experiences

- Assist with prioritizing and problem-solving

- Offer assistance for family membersto facilitate communication andeffective functioning

- Assess and refer when indicated

- Provide information on disasterstress and coping, children’sreactions and families

- Provide information on referralresources

20Potential R

isk Groups

Ages BehavioralSymptoms

PhysicalSymptoms

EmotionalSymptoms Intervention Options

Disaster Reactions and InterventionSuggestions (Continued)

OLDERADULTS

- Withdrawal andisolation

- Reluctance toleave home

- Mobility limita-tions

- Relocationadjustmentproblems

- Worsening ofchronic illnesses

- Sleep disorders- Memory problems

- Somatic symp-toms

- More susceptibleto hypo- andhyperthermia

- Physical andsensory limitations(sight, hearing)interfere withrecovery

- Depression

- Despair aboutlosses

- Apathy

- Confusion,disorientation

- Suspicion

- Agitation, anger- Fears of institu-

tionalization- Anxiety with

unfamiliarsurroundings

- Embarrassmentabout receiving“hand outs”

- Provide strong and persistent verbalreassurance

- Provide orienting information- Use multiple assessment methods as

problems may be under reported- Provide assistance with recovery of

possessions

- Assist in obtaining medical andfinancial assistance

- Assist in reestablishing familial andsocial contacts

- Give special attention to suitableresidential relocation

- Encourage discussion of disasterlosses and expression of emotions

- Provide and facilitate referrals fordisaster assistance

- Engage providers of transportation,chore services, meal programs,home health, and home visits asneeded.

21Potential Risk Groups

CULTURAL AND ETHNIC GROUPS

Workers must respond specifically and sensitively to thevarious cultural groups affected by a disaster. Ethnic andracial minority groups may be especially hard hit, becauseof socioeconomic conditions that force the community tolive in housing that is particularly vulnerable. Languagebarriers, suspicion of governmental programs due to priorexperiences, rejection of outside interference or assistance,and differing cultural values can present challenges forworkers in gaining access and acceptance.

Cultural sensitivity is conveyed when disaster informationand application procedures are translated into primaryspoken languages and available in non-written forms. Culturalgroups have considerable variation regarding views of loss,death, home, the family, spiritual practices, grieving, celebrat-ing, mental health, and helping. It is essential that workerslearn about the cultural norms, traditions, local history, andcommunity politics from leaders and social service workersindigenous to the groups they are serving. Establishing workingrelationships with trusted organizations, service providers, andcommunity leaders often facilitates increased acceptance. It isespecially important for workers to be respectful, well-informed, and to dependably follow through on stated plans.

PEOPLE WITH SERIOUS AND PERSISTENT MENTALILLNESS

Many disaster survivors with mental illness function fairlywell following a disaster, if most essential services have notbeen interrupted. They have the same capacity to “rise to

22 Potential Risk Groups

the occasion” and perform heroically as the general popula-tion during the immediate aftermath of the disaster. How-ever, for others who may have achieved only a tenuousbalance before the disaster, additional mental health sup-port services, medications, or hospitalization may be neces-sary to regain stability. For survivors diagnosed with Post-traumatic Stress Disorder (PTSD), disaster stimuli (e.g.,helicopters, sirens) may trigger an exacerbation due toassociations with prior traumatic events.

The range of disaster mental health services designed forthe general population is equally beneficial for survivorswith mental illness; disaster stress affects all groups. Work-ers need to be aware of how people with mental illness areperceiving disaster assistance and services and build bridgesthat facilitate access where necessary.

PEOPLE IN GROUP FACILITIES

People who are in group facilities or nursing homesduring a disaster are susceptible to anxiety, panic, andfrustration as a consequence of their limited mobility anddependence on caretakers. The impact of evacuation andrelocation on those with health or functional impairmentscan be tremendous. Dependence on others for care or onmedical resources for survival contributes to heightened fearand anxiety. Change in physical surroundings, caregivingpersonnel, and routines can be extremely difficult.

Both the staff and patients/residents of evacuated ordisaster-impacted group facilities are in need of support

23Potential Risk Groups

services. Interventions for these groups include reestablish-ing familiar routines, including residents in recovery andhousekeeping activities when appropriate, providing sup-portive opportunities to talk about disaster experiences,assisting with making contact with loved ones, and provid-ing information on reactions to disaster and coping.

HUMAN SERVICE AND DISASTER RELIEF WORKERS

Workers in all phases of disaster relief, whether lawenforcement, local government, emergency response, orsurvivor support, experience considerable demands to meetthe needs of the survivors and the community. Dependingon the nature of the disaster and their role, relief workersmay witness human tragedy, fatalities, and serious physicalinjuries. Over time, workers may show the physical andpsychological effects of work overload and exposure tohuman suffering. They may experience physical stresssymptoms or become increasingly irritable, depressed, over-involved or unproductive, and/or show cognitive effects likedifficulty concentrating or making decisions. Mental healthworkers may intervene by suggesting or using some of thestrategies described in the next section.

25

Working with disaster survivors is inevitably stressful attimes. The long hours, breadth of survivors’ needs

and demands, ambiguous roles, and exposure to humansuffering can affect even the most experienced professional.While the work is personally rewarding and challenging, italso has the potential for affecting workers in adverse ways.Too often, staff stress is addressed as an afterthought.

Preventive stress management focuses on two criticalcontexts: the organizational and the individual. Adopting apreventive perspective allows both workers and programs toanticipate stressors and shape crises rather than simplyreacting to them after they occur. Suggestions for organiza-tional and individual stress prevention and management arepresented in the next four pages.

STRESS PREVENTIONAND MANAGEMENT

Stress Prevention and Management

26

Organizational Approaches forStress Prevention and Management

ResponseDimension

EFFECTIVE MANAGEMENTSTRUCTURE &LEADERSHIP

-Clear chain of command and reportingrelationships

-Available and accessible clinical supervisor

-Disaster orientation provided for all workers

-Shifts no longer than 12 hours with 12 hoursoff

-Briefings provided at beginning of shifts asworkers exit and enter the operation

-Necessary supplies available (e.g., paper,forms, pens, educational materials)

-Communication tools available (e.g., cellphones, radios)

CLEAR PURPOSE &GOALS

-Clearly defined intervention goals andstrategies appropriate to assignment setting(e.g., crisis intervention, debriefing)

FUNCTIONALLY DEFINEDROLES

-Staff oriented and trained with written roledescriptions for each assignment setting

-When setting is under the jurisdiction ofanother agency (e.g., Red Cross, FEMA), staffinformed of mental health’s role, contactpeople and expectations

TEAM SUPPORT -Buddy system for support and monitoringstress reactions

-Positive atmosphere of support and tolerancewith “good job” said often

Stress Prevention and Management

27

PLAN FOR STRESSMANAGEMENT

-Workers’ functioning assessed regularly

-Workers rotated between low-, mid-, and highstress tasks

-Breaks and time away from assignmentencouraged

-Education about signs and symptoms ofworker stress and coping strategies

- Individual and group defusing and debriefingprovided

-Exit plan for workers leaving the operation:debriefing, reentry information, opportunity tocritique, and formal recognition for service

ResponseDimension

Organizational Approaches forStress Prevention and Management (Continued)

Stress Prevention and Management

28

Individual Approaches forStress Prevention and Management

ResponseDimension

MANAMEMENT OFWORKLOAD

-Task priority levels set with a realistic workplan

-Existing workload delegated so workers notattempting disaster response and usual job

BALANCED LIFESTYLE -Physical exercise and muscle stretching whenpossible

-Nutritional eating, avoiding excessive junkfood, caffeine, alcohol, or tobacco

-Adequate sleep and rest, especially on longerassignments

-Contact and connection maintained withprimary social supports

STRESS REDUCTIONSTRATEGIES

-Reducing physical tension by taking deepbreaths, calming self through meditation,walking mindfully

-Using time off for exercise, reading, listeningto music, taking a bath, talking to family,getting a special meal—to recharge batteries

-Talking about emotions and reactions withcoworkers during appropriate times

Stress Prevention and Management

29

Individual Approaches forStress Prevention and Management (Continued)

ResponseDimension

SELF-AWARENESS -Early warning signs for stress reactionsrecognized and heeded

-Acceptance that one may not be able to self-assess problematic stress reactions

-Over identification with survivors’/victims’ griefand trauma may result in avoiding discussingpainful material

-Understanding differences between profes-sional helping relationships and friendships

-Examination of personal prejudices andcultural stereotypes

-Vicarious traumatization or compassion fatiguemay develop

-Recognition of when own disaster experienceor losses interfere with effectiveness

Stress Prevention and Management