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Training Manual
for Mental Health and Human Service Workers
in Major Disasters
SECTION 1
Background and Overview
Mental health intervention has become a valued dimension of
immediate and long-term disaster response. Psychological recovery is recognized as a focus for relief efforts, along with repairing homes and rebuilding bridges. Emergency responders, disaster workers, and community members now receive mental health support following most large-scale disasters. Mental health professionals have readily stepped into the disaster milieu to provide counseling, debriefing, school interventions, case management, and consultation.
Legislative authority is given to the President under Section 416 of The Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988 (Public Law 100-707) to provide training and services to alleviate mental health problems caused or exacerbated by major disasters. The Act reads as follows:
Crisis Counseling Assistance and Training. The President is authorized to provide professional counseling services, including financial assistance to State or local agencies or private mental health organizations to provide such services or training of disaster workers, to survivors/victims of major disaster in order to relieve mental health problems caused or aggravated by such major disaster or its aftermath.
The Crisis Counseling Assistance and Training Program (commonly referred to as the Crisis Counseling Program) is managed by the Federal Emergency Management Agency (FEMA) in cooperation with the Center for Mental Health Services (CMHS).
Purpose of the Manual
While each disaster and community is unique, States face similar challenges as they mobilize the resources to provide post-disaster mental health services. Disaster mental health providers, program planners, and administrators must quickly acquaint themselves with "the basics" of disaster mental health to be able to design and deliver services that are effective. A primary purpose of this Manual is to present an overview of essential information including: how disasters affect children, adults and older adults, the importance of tailoring the program to fit the community, descriptions of effective disaster mental health interventions, and strategies for preventing and managing worker stress.
Another purpose of the Manual is to efficiently assist mental health administrators, planners, and disaster mental health trainers as they develop the training component of their crisis counseling project. Specific disaster mental health training is critical for all professional and paraprofessional personnel associated with a disaster mental health recovery program. This training can guide crisis counseling project development so that the wisdom gathered from twenty-five years of disaster mental health intervention is reflected in program services. A course outline for comprehensive disaster mental health training complete with overheads and handouts is in Section 6 of this Manual. The overheads and handouts have been prepared for immediate use by the trainer. Additional skill training for paraprofessional staff is described in
Section 7.
Crisis Counseling Programs typically reach out to human service agencies and organizations in the community. Examples of service provider groups are disaster relief workers, health care professionals, church volunteers, senior center personnel, building permit inspectors, public assistance workers, food bank workers, day care staff, and agricultural extension employees. Crisis counseling staff provide educational presentations and materials on disaster mental health so that local human service workers are better equipped to serve their constituencies following the disaster. The material provided in this Manual, especially the summary tables and handouts, will be useful for human service workers. A description of training options for human service workers is included in
Section 7.
Why Special Training?
Specific training is essential because post-disaster mental health services are significantly different from the work activities of most mental health professionals. A supportive conversation or a focused problem-solving session over a cup of coffee, at a feeding van, or at a town meeting are essential activities in disaster work. While a background in crisis intervention or critical incident stress is helpful, it does not prepare a mental health professional for the range of issues encountered in communities during the months following a disaster.
As public funding for mental health services has become primarily limited to serving those with serious and persistent mental illnesses, many mental health workers have become less experienced in dealing with the general population who may be coping with loss, disruption, and, in some cases, tragedy. Many outpatient psychotherapists, accustomed to the fifty-minute session in an office, find providing support services in people's homes or at shelters outside their comfort zone. While case managers for people with mental illness and geriatric specialists are skilled at accessing resources and providing services outside an office, they benefit from training on disaster issues. Disaster mental health training builds on each mental health professional's existing strengths and experiences and provides a framework and specific interventions appropriate to the disaster context.
Newcomers to disaster work are impressed with the "alphabet soup" of agencies, centers, and services (e.g., DFO, EOC, ARC, FEMA, VOAD, SBA). For most, the bureaucratic context of disaster relief work is new, almost like operating in a different culture. Training provides the big organizational picture of disaster recovery, so that mental health workers can navigate in the new environment and utilize available resources.
Crisis Counseling Programs typically find that paraprofessionals from the affected communities can be highly effective community outreach workers. When paraprofessional workers represent the groups they are serving, for example, older adults, people of color, or people from different ethnic or cultural groups, they often readily gain access. Although these individuals may be "natural helpers" or "peer counselors" with other groups, specific training on disaster and mental health issues facilitates their integration into the program. In addition to specific disaster mental health training, paraprofessionals benefit from training and practice with basic counseling skills.
Occasionally, States will provide disaster mental health training for disaster mental health workers only, and not include those who will be providing clinical supervision or program administration. Disaster program experts emphatically concur that when all parties involved with a program have received training in disaster mental health, conflicts and misunderstandings that undermine program effectiveness can be avoided.
Overview of Resources
This Manual is intended as a companion resource to Disaster Response and Recovery: A Handbook for Mental Health Professionals (CMHS, 1994). While the Handbook provides practical information for planning and implementing disaster mental health services, this Manual focuses more on what workers need to know to provide those services. This Manual includes sections on how communities and survivors respond to disaster, potential at-risk groups, and stress management for staff. Recognizing the necessity for service providers to quickly develop competency in a new context, topic presentations are focused and brief. Additional readings are suggested in the text and listed at the end of sections. These have been selected because they provide synthesized research reviews and practical suggestions, and are readily available.
A comprehensive training course outline, which describes the specific skills, knowledge, and attitudes required for disaster mental health, is in Section 6. When the training content is not included in this manual, the trainer is directed, in most instances, to a chapter in the Handbook. Additional resources from the Center for Mental Health Services are extremely useful as well.
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