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Training Manual
for Mental Health and Human Service Workers
in Major Disasters
SECTION 7
Additional Training Needs and Options
Crisis counseling staff training serves multiple functions. In the immediate phase of disaster response, training quickly provides necessary logistical and intervention information. This training is action-oriented, brief, and repeated as new mental health staff join the operation. Section 5 describes this Initial Start-up Training. In addition, Chapter Two in Disaster Response and Recovery: A Handbook for Mental Health Professionals provides an excellent overview of issues pertinent to selecting and training disaster mental health staff (CMHS, 1994).
Several months after the disaster a stable group of workers, who will remain through the duration of the program, have been hired. The crisis counseling project's organizational structure and procedures have become further defined and resemble that of an established program, as opposed to a rapid response mobilization. The comprehensive disaster mental health training presented in Section 6 may be conducted at this point in the implementation process, or may have been offered earlier. This comprehensive training provides extensive disaster mental health background and intervention information, and also addresses team development and worker stress management. During the remaining months of the program in-service continuing education is essential, as new training needs are identified and phase-related issues emerge.
Paraprofessional "peer counselors" are valuable members of disaster mental health recovery programs. While bringing varied and salient life experiences to their disaster work, paraprofessionals also need additional training on counseling skills, mental health assessment and referral, and ethical issues.
This section addresses additional training needs beyond the comprehensive training outlined in Section 6. Training options included in this section are:
Training for Paraprofessional Staff
Training for Human Service Workers
Topics and Considerations for In-Service Training
Training for Paraprofessional Staff
Paraprofessional counseling staff may be recruited from existing community programs, such as, senior outreach services, church-sponsored programs, ethnic group-oriented service programs, American Red Cross volunteers, or farm advocacy volunteers. These workers should reflect the demographic characteristics and ethnic and cultural groups present in the disaster-affected community. Solid interpersonal communication skills, the ability to work cooperatively with others, the psychological capacity to help others without judgment, and the ability to maintain confidentiality are desired qualities for paraprofessional counselors.
When paraprofessional staff have participated in a training session on counseling skills prior to the program's comprehensive disaster mental health training, they can engage with the disaster information from a broader context and foundation. An initial two-day training course with regular weekly or bi-weekly continuing education and supervision sessions is suggested.
The following topics are recommended for inclusion in training for paraprofessional staff:
Counseling Skill Development
- Active Listening - Using nonverbal cues, giving minimal encouragements (nods and "uh-huhs"), conveying empathy, paraphrasing, reflecting feelings, summarizing, differentiating content, and feelings.
- Asking Questions - Interviewing techniques, asking open and closed questions, focusing with questions, avoiding using questions to give advice or make judgments.
- Providing Support and Encouragement - Establishing rapport, empowering the survivor, giving positive feedback about coping strengths, offering suggestions, avoiding communication blocks, and unhelpful phrases.
Counseling Interventions
- Crisis Intervention - Assessing capacity to live independently, evaluating suicide and dangerousness risk, giving reassurance, building hope, protocols for immediate response, procedures for consultation, referral, and follow-up.
- Listening to Disaster Experiences - Prompting telling (and retelling) of disaster stories, exploring feelings and reactions, educating about disaster stress, and healthful coping strategies.
- Problem-solving - Identifying and defining the problem, exploring feelings, brainstorming solutions and resources, setting doable goals, taking action, and evaluating results.
Self-Awareness
- Motivations for Helping - Exploring personal experiences, understanding helping relationships vs. friendships, over identifying with survivors.
- Awareness of Feelings - Identifying and articulating feelings, becoming familiar with range of "feeling words," and tolerating expressions of "uncomfortable" emotions.
- Stereotypes and Values - Exploring personal biases and prejudices, avoiding judgmental attitudes, and promoting respect for differences.
Assessment of Mental Health and Other Problems
- Basic overview of depression, anxiety, post-traumatic stress disorder, alcohol and drug abuse, child and elder abuse, mental illness, cognitive impairment/dementia - Symptom recognition, initial assessment strategies, procedures for consultation, referral, and follow-up.
Legal, Ethical and Program Considerations
- Confidentiality, state law and reporting requirements, and procedures;
- Record keeping, program reporting, and monitoring;
- Boundaries of relationship with clients;
- Stress prevention and management (Section 4); and
- Consultation, supervision, and continuing education.
Paraprofessional staff training emphasizes that the helping person is in a privileged position. Helping someone in need implies a sharing of problems, concerns, and anxieties-sometimes with very personal details. This special sharing cannot be done without a sense of trust, a trust which is built upon mutual respect and includes the explicit understanding that all discussions are confidential and private. This mutual respect also involves acceptance of the survivor's experience, thoughts, and feelings-judging or moralizing or telling the survivor how he or she should feel only alienates and undermines the helping relationship.
Counseling skill building through role-playing, observing role models, discussing case examples, and giving and receiving feedback helps paraprofessional staff gain competency. Having clear guidelines for assessment and referral helps counselors to function within the boundaries of their training. Training facilitators must be adept at identifying and processing feelings, evaluating and promoting counseling skill development, and providing clear and concise procedures for challenging situations. Training for paraprofessional counselors should be ongoing and integrated with case consultation and practicing counseling skills.
Training for Human Service Workers
Human service workers may be directly involved in the disaster relief effort through Federal, State or local agencies, emergency services, law enforcement, the American Red Cross, the Salvation Army, or local churches. Most will benefit from focused training on disaster mental health issues geared to their respective roles. The Field Manual for Mental Health and Human Service Workers in Major Disasters (CMHS, Rev. ed. in press) that accompanies this training manual is an excellent resource to provide as an adjunct to training. Developing a good working relationship with these entities for mutual referrals is a valuable by-product of such training.
This training can be accomplished in several ways. Representatives from the various agencies and organizations may attend the comprehensive disaster mental health course. When this occurs, the trainer should rearrange the training schedule so that representatives from outside agencies attend for the first day, or possibly mornings, only. The training agenda should efficiently address these representatives' needs, while not compromise meeting the diverse training needs of the crisis counseling staff.
Another alternative is providing on-site disaster mental health training with each group. The training can then more specifically address each group's needs. Activities, overheads, and handouts can be used from the comprehensive training as needed. However, losing the exposure to the entire crisis counseling staff and their enthusiastic efforts is a trade-off.
Disaster relief and recovery workers comprise one type of human service worker involved with survivors. Other disaster-related service workers encounter survivors in the course of conducting business or providing services. Examples are home health nurses, public assistance workers, school personnel, building permit inspectors, church staff, primary health care providers, or hairdressers. Disaster mental health training and educational materials can assist these individuals to better serve disaster survivors and to refer those in need to the crisis counseling project. Also, these individuals can distribute disaster stress and coping brochures to survivors.
The program may establish a "task group" to design outreach strategies, training presentations, and educational materials for these collateral providers and human service workers in the community. Since experience has shown that many survivors are more likely to talk with their physician, pastor or someone known to them before talking with a "counselor," outreach and education with these groups is extremely important.
Topics and Considerations for In-Service Training
The comprehensive training course provides staff with a good introduction to disaster mental health. As staff engage with the disaster-affected communities over time, additional training needs become apparent. These identified training needs may involve particular population groups, current disaster recovery issues, specific mental health or substance abuse problems, or needed modifications of intervention strategies. Also, timing or phase-related topics such as anticipating the beginning of the next disaster season or the one-year anniversary of the disaster, may become relevant.
In-service training also serves the important function of bringing the staff together to strengthen group cohesion, social support, morale and creativity. The focus of the session may be tending to the emotional challenges of disaster work through personal sharing, case consultation, and problem-solving new solutions. Some of the suggestions and exercise ideas in Section 4, "Stress Prevention and Management," can be included in the training. A skilled facilitator may identify organizational issues or procedures that may be interfering with staff well being or program effectiveness.
The following are examples of in-service training topics:
Media relations and disaster mental health community education
Public speaking skills for disaster mental health presentations
Stress management interventions for survivors, disaster workers, and program staff
More extensive training on serving children, older adults, or ethnic/cultural groups in the community
Long-term family stress issues following disaster
Long-term disaster recovery issues and interventions
Disaster mental health role and interventions with post-traumatic stress disorder, alcohol and drug abuse problems, or complicated bereavement
Expressive intervention approaches (art, music, drama, writing, community projects) with adults and children
Support groups and group dynamics
Community organizing to address unmet disaster-related needs
Anniversary reactions and commemorative events
Specialized topics on survivor issues (scam contractors, resources for referral and unmet needs, permitting process, insurance, etc.)
Specialized topics on local disaster issues (warning systems, disaster preparedness, floodplain management, seismic safety, etc.)
Steps for program phase-down and termination
Final celebration of program successes and lessons learned
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