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Training Manual
for Mental Health and Human Service Workers
in Major Disasters
SECTION 5
Setting Up Disaster Mental Health Services Training
To be an effective disaster mental health worker, one must be flexible, easily able to establish rapport, respectful of differences among people, and tolerant of ambiguity and confusion. Not everyone is suited to the varied rigors of disaster work. In the initial stages of program implementation, mental health recovery program administrators must recruit and select a cadre of mental health professionals and paraprofessionals to serve their communities effectively, if one does not already exist. Administrators seeking guidelines and suggestions may refer to Chapter 2, "Selection and Training of Disaster Mental Health Staff" in Disaster Response and Recovery: A Handbook for Mental Health Professionals (CMHS, 1994).
Participation in disaster mental health training prepares program staff for the unique organizational, procedural, emotional, and environmental aspects of disaster work. While new staff undoubtedly have relevant skills from their prior professional activities, disaster mental health work presents most with some significantly different challenges. The overwhelming response of mental health professionals after disaster mental health training is, "I didn't know how useful this would be!"
Effective training combines lecture presentations, films, skills practice, self-awareness exploration, group discussion, and experiential learning. Participants are exposed to case scenarios and videotapes that simulate disaster situations, so they are able to explore their own reactions and achieve some stress-inoculation prior to assignment.
The training process is not designed to be a "debriefing" for those who personally suffered disaster losses. If it is necessary to involve staff who are also disaster survivors, they should participate in a supportive group debriefing session prior to the training and be individually assessed. Staff and program supervisors may find that their personal disaster reactions interfere with their functioning as disaster mental health workers. Survivor staff members should be cautioned about their increased vulnerability and closely monitored and supported by supervisors.
Initial Start-up Training
In the immediate aftermath of the disaster, administrators must rapidly identify and deploy staff. If a disaster-trained group of available mental health professionals does not already exist, then training becomes a priority. Even those with prior disaster mental health training need to be oriented to the current disaster and response operation. An initial four to eight-hour start-up training should be offered quickly and repeated as new staff come on board.
The accompanying pamphlet Field Manual for Mental Health and Human Service Workers in Major Disasters (CMHS, Rev. ed. in press) to this Manual also provides a practical overview and "how to" information. It is a valuable pocket guide for ready-reference in the field.
Comprehensive Disaster Mental Health Training
Comprehensive training typically occurs after the majority of staff have been hired and toward the end of the immediate disaster response phase. This may be 3-6 weeks after the disaster. Depending on program implementation and the timing of hiring staff, it may be most appropriate to provide comprehensive training twice-once at 3-6 weeks and again after 3-4 months. Training should be mandatory for all staff and volunteers who will be involved with the program, including supervisors and administrators.
This comprehensive training serves a number of functions. In addition to providing information about people's reactions to disaster and the range of disaster mental health interventions, training goals are to:
Develop group cohesion and a program identity
Orient staff to organizations involved with disaster response and recovery
Establish norms and procedures for staff stress management
Communicate the goals, mission, and philosophy behind the Crisis Counseling
Program
Present the plan and rationale for on-going supervision, case consultation, and in-service training
Communicate program policies and procedures with regard to organizational structure, financial management, and program activity data collection
While the initial training is a "start-up" training, the comprehensive training can be viewed as a program "kick off." This can be a time that old and new program staff convene to form a collaborative and cohesive work team. Procedures for program monitoring, staff stress management, and the long-term program structure have been established and can be further implemented through the training.
Paraprofessional outreach workers will need training beyond the comprehensive disaster mental health training. They bring a range of life and work experiences that enriches the program. However, it is important that they participate in specific training on counseling skills, intervention guidelines, and when and how to make referrals (see Section 7). Providing this training is helpful prior to the comprehensive disaster mental health training, so paraprofessional staff have a broader framework for integrating the information. Training should be ongoing so that skills can be developed and honed over time. Close and supportive supervision is helpful during the early phase of the program. While it is important that paraprofessional staff participate in skill-building training, inadvertently encouraging a division between program staff would be destructive. Program administrators must address the need for additional paraprofessional training without compromising group cohesion and team support.
Setting Up the Training
The training should be held in a comfortable setting with audio-visual equipment suitable for the room and size of the group. Although less than thirty participants is an ideal size for training, logistics may dictate that the group be larger. Under those circumstances, having additional small group facilitators and trainers to review and give feedback on role-plays enhances the depth of the training.
Selecting the Trainer
In the immediate response to the disaster, the importance of rapidly training and deploying disaster mental health staff may require the program to involve a local mental health professional with no disaster experience as the trainer. While having prior disaster experience is preferable, it may not be practical. Alternate relevant background experience might include: crisis intervention in a mental health center, critical incident stress management with emergency service workers, experience in community-based settings, breadth in professional and clinical work, and effectiveness as an educator. This Manual and Disaster Response and Recovery: A Handbook for Mental Health Professionals (CMHS, 1994) will enable the trainer to become oriented quickly.
The comprehensive training must be taught by a mental health professional with disaster experience and, ideally, experience in a nine-month crisis counseling grant. Not only should the trainer have the requisite knowledge to present the material, but also he or she should be an engaging presenter and highly skilled with group processing of emotions. The trainer must be able to model skills, as well as teach them. Trainers coming from outside the geographic area of the disaster will need to become familiar with the local disaster-its impact, population groups affected, damage assessment information, dynamics of the disaster having psychological implications, and relief efforts to date. Grant applications, bulletins or summaries from the State's emergency management department or from FEMA, videotapes of news coverage, and summary newspaper articles can be useful sources for gathering this background information.
The comprehensive training program could include different trainers with special expertise in certain topics, such as children or older adults. These trainers should also be familiar with long-term disaster recovery so that their presentations are immediately relevant to the needs of the participants. Typically, a representative from FEMA and/or the State department of emergency management will present the portions of the training on state and Federal disaster assistance programs.
When the program is serving particular cultural or ethnic groups, presentations by representatives of those groups should be included in the training. These representatives may be community leaders, social service agency workers, or educators on cultural sensitivity. Staff members from those groups may contribute to the training process.
Who Should Attend?
When individuals who have not been oriented to disaster mental health issues administer programs, unnecessary conflicts and inconsistencies arise. Therefore, it is essential that all paraprofessional and mental health professional staff, program administrators, and supervisors associated with the program attend the training.
Frequently representatives from FEMA, CMHS, the local department of emergency management, or the American Red Cross attend the training. These individuals bring valuable information and perspective. Their presence and participation convey the importance of the joint effort of disaster recovery. Program administrators need to balance the need for a cohesive group training vs. including people from adjunct agencies and referral sources. As will be discussed in Section 7, the training may be designed so that a broader group is included in the first day and the program staff only in the remaining days.
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