Ms. McGee: Hello and welcome to
our podcast Deployment Supports for DBH Responders, presented by
the Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center or SAMHSA DTAC. My name is Lori McGee and I’ll
be your host for the podcast. I currently serve as the
Deputy Director for SAMHSA DTAC. There I supervise the
development of curriculum and trainings and lead the Crisis
Counseling Assistance and Training Program, or CCP
as you might know it. Over the past 12 years I have
worked with a variety of special populations, including
delinquent youth, women and families in crisis, and populations receiving mental health services. I would like to take a brief
moment to thank SAMHSA for their support of this podcast, particularly Miss Julie Liu; her guidance and support through the development of this presentation has been most helpful
and appreciated. Now it’s my pleasure to
introduce Miss Julie Liu as our first presenter. Miss Liu is a Public Health
Advisor for the Crisis Counseling Assistance and
Training Program with the Emergency Mental
Health and Traumatic Services Branch at SAMHSA. She brings 16 years of clinical
experience as a mental health specialist and over 9 years of
crisis counseling experience. Welcome Miss Liu. Ms. Liu: Thanks Lori. As Lori mentioned, my name
is Julie Liu and I am a Public Health Advisor at SAMHSA. I am going to introduce our
topic and goals for today, provide an overview of
the presentation, and introduce our speaker. This podcast is intended to
assist DBH responders and their family members by reviewing
pre- and post-deployment guidelines and ways to prepare oneself and family members for the stress of deployment and reintegration into the family. Our purpose today is to increase
awareness of the unique issues disaster behavior health
responders face, especially with numerous or long-term assignments; to provide pre-deployment guidelines to assist disaster behavioral health responders as they prepare for numerous response assignments; to provide
suggestions for preparing family members of responders being
deployed; and to provide guidelines for post-deployment
and reintegration with the family members and
routine employment. I am pleased to
introduce our next presenter, Dr. April Naturale. Dr. Naturale is a traumatic
stress specialist with a 25-year history in mental health administration, she directed the New York 9/11 disaster mental
health response, and spent several years in the Gulf Coast
after the large-scale hurricane that devastated the area. Dr. Naturale has provided
disaster consulting and training throughout the U.S.
and internationally. She helped to launch SAMHSA’s
National Suicide Prevention Lifeline and recently directed
the BP Deepwater Horizon Oil Spill Distress Helpline, as well as the 9/11 Tenth Anniversary Healing and Remembrance Program. Dr. Naturale currently works
with ICF International where her primary responsibility is as a Senior Advisor to the Substance Abuse and Mental Health Services Administration Disaster Technical Assistance Center. April, since you have been a
responder and I know you’ve been down in Mississippi immediately
after Katrina, how would you possibly prepare for responding to a disaster like that? Dr. Naturale: Well that’s a
really good question, Julie, and thank you for the introduction
and this opportunity. Deployment is a very important
subject and we know that so many people across the States are
being deployed over and over because of the numerous disasters more recently. Basically the answer is that we
often don’t know what to expect and that’s why we go
through these pre-deployment prep guidelines to help us. Pre-deployment means what you do
before you get in the field. In some situations you may be
planning for a few weeks and in others you may have
only a few hours. Either way, what you do before
going into the field can highly influence whether you have a
negative experience or not. People generally report that
they feel they can handle anything as long as
they are prepared. We can ask those who are there,
and our team leader when we get our assignment-who are
in contact with those in the field-what to expect. Try to gather information about the area, geographically
and demographically. Is it cold or hot? This way you know what to wear. Are there many
different ethnicities living in the disaster area? Or immigrants whose primary
language is not English? There are lots of
questions that we can ask to help prepare ourselves. Also, we should think about
bringing our own supplies as best we can, so that we don’t
take away from survivors. I will talk about what some of
those supplies should be. There are also things that you
want to talk about with your family so that they
feel prepared as well. We’ll go through those
guidelines as well as then talk about what we do in the field
and then move to what might help in the post-deployment/
after-assignment period. Pre-deployment has to do
with preparing yourself, being aware and being prepared. One of the most important things
to realize is that we shouldn’t run into the field or into a
scene if we’re not part of an organization and have
been assigned. As most of you in the field of
disaster behavioral health know, it’s best that you are working
with a response agency. There are many problems when
people self-deploy, going in by themselves. A seasoned responder
knows that it is actually often not safe to do so. You can put yourself in danger
as well as being in the way of responders and actually
cause more of a problem. One of the things that you can
do before going into the field is be connected with some kind
of an agency so that when a disaster does happen you’ll already be aligned with an agency and be called
under their guidance. You also need to
know your own skills and what you can and can’t do. This is critical. You may be a trauma therapist
who sees a lot of severely traumatized patients
in your practice, but that’s not disaster work. If you are listening to
this podcast and thinking “What the heck are they
talking about?” then I am definitely talking to you. You need to train in
Psychological First Aid, crisis counseling, and community
outreach as they are related to disaster work in
order to assure that you do no harm in the field. We don’t do diagnosing or
conducting formal mental health treatment in the acute and even
in the immediate phases; doing so can actually cause harm. There are exceptions, of course, but overall this rule applies. Also, if you’re in the field in
the early days or are assigned as part of a larger emergency
response system, it’s really helpful if you know the Incident Command System and the National Incident Management System. FEMA offers these courses
online for free. If you don’t know the language
of incident command, you really won’t be able to communicate
with the other response disciplines very well. You also need to know yourself. If you’re called to a disaster
response, stop and think if you’re able to say yes
at that point in time. Are you in a fragile place? Have you just experienced
the death of a family member or had an accident of some sort? These would be indicators that
it’s probably not the best time for you to answer a response. There are others who can go. So evaluate this
question with the truth. Can you really say yes? And of course, while you would
certainly contribute to the effort, the community
can manage without you. You may be able to come
in at another time. Again, be careful so that you
don’t become a burden if you’re not in good shape in the field. I can’t tell you how many times
I’ve been called out to special operations to pull someone out
of the field and get them home safely because they were either exhausted or hypermanic or in some way really dysfunctional. And they couldn’t recognize
the danger that they were in. We also need to know
the environment. A lot of people who respond to a
disaster for the first time don’t realize that they may
actually be entering really unpleasant conditions, physically and emotionally. You have to realize that you
might be walking around in mud and muck with bugs,
or in dirty water. In some cases, you may have to
sleep out in a tent maybe not the comfort of a fuzzy warm
blanket or a pillow. We have to remember,
the response is not about us or about our comfort. So we can’t run around
complaining or expecting others to find supplies for us. We’re there to help, and
certainly not to take any supplies from the survivors
in the community. Again, bring what you think that
you may need in order to assure that you can do your job in the
field and not burden others. If supplies are available
for responders, then of course avail yourself of them. But be prepared that supplies
may not be there for you. For example, everyone in Katrina
knew there was no electricity, there were few spots that had
clean water, and that most of the food in the
area had spoiled. Three days post-disaster
what would you bring into the field with you? When I readied myself, I filled
my backpack with protein bars, lots of hand wipes, a first aid
kit, extra medicines, and supplies for bug
bites of course. Then once I was past security on
my way there I was able to add some bottled water to the pack. I was self-sufficient
for at least a few days. Think about what things would
make you the most comfortable that are easy to take in a
backpack that will help you to get your job done
in an area where supplies may not plentiful. Ms. McGee: Dr. Naturale,
that is really helpful. I feel like I could almost go
out and at least be prepared, myself, for a day or
two in the field. What can I do to help my family? They are going to be
worried about me. Dr. Naturale: That’s
for sure Lori. You hit it right on the head. Communication is key to
decreasing worry and anxiety. It’s really not fair for us to
expect that families should be without information
about our status. It’s important before you
go into the field to let your family-let them
know what you know. Who is your lead? How do you get in touch
with that person? Where do you expect that
you are going to be? And also, how can they
reach you in an emergency? Additionally, you should make a
plan-before you leave-with them. Agree on when you’ll
get in touch. Are you going to call
each other early in the morning or late in the evening? And do follow through. You know you’re going to be busy
in the field, but commit to calling when you say
that you’re going to. It will help decrease your
family’s anxiety and it will actually support you, even
if you don’t think so. Then when you get into
the field, that’s when you’re actually on assignment. Now, some people may be going
into the field and going home every day, depending on the
location, but lots of people are assigned to a different site away from home and they may be staying at a facility with other responders for a week or two, not usually longer than that. “In the field” usually means the
spot of the disaster where the responders are staying
and working to respond to the survivors who are there. Again, we want to make sure
that you know your assignment. If you have any questions make
sure that you talk to your team leader or whoever it is that
assigns you your job before you get into the field
and before you start going out into the field. What’s the overall
mission of the job? What are your roles
and responsibilities? How do you get in touch with
your leader on a regular basis? Schedule your check-ins with
your team leader and make sure that you clarify anything
that you don’t understand. Don’t walk around thinking
“I have to figure out what to do by myself.” The team leader is
there to help you. You also might want to ask who
your teammates are and how to get in touch with them as soon
as you get into the field. You also especially want to know
what their roles are, so that you understand what
each person is doing. Again, you’ll also need to know
is there anything else that you need to know about them. Remind yourself too that you
need to maintain your boundaries even within the need
for flexibility in the disaster field. So what does this mean? It really means that you need to
remain professional with your teammates and
respect their space. You may be all living in the
same place but people come into the job to work and we need
to make sure that we’re not intrusive with each other. Ask for help and support in
the appropriate venue, like in group meetings or debriefings. Of course, if you need to talk
to somebody go to your team leader or maybe one of your
colleagues for a short time but don’t expect them to stay up all
night trying to make you feel better when everyone needs to
get their sleep to go back out in the field the next day. Also, when you’re in
the field you need to understand the chain of command. Understand that security,
permissions, schedules, things will likely change and often. As a responder you
need to tolerate these things with good grace. It’s not the time for us to
make complaints or demands. Remaining safe in the field
means that you need to know who’s in command, where you get
your instructions from, and also you need to know where
to stay away from. There’s generally no need for
disaster behavioral health responders to be in a hot zone
-that is a danger zone -unless you are specifically assigned to
work with certain other responders who are
there, and you’ll get special instruction about that. Also, if something comes up
that you feel you aren’t competent to handle, then don’t. Go to your team leader and find
out who is the more appropriate person to handle this. You don’t want to be
practicing outside the scope of your own competence. Also, in the field I am going to
tell you the old crisis counseling rule if you don’t
know it already, we used to say this all the time, “Don’t look
at what you don’t need to see and don’t listen to gruesome stories over and over again.” The information that you
need is the information that will come from your team leader. Try to avoid sitting around with
your colleagues and telling terrible stories about all
of the awful things that you may have seen or heard. These can only increase
your secondary stress. Learn what language works for
you that will excuse you from participating in any negative
activities or attitudes. We need to practice stress
management all the time by protecting ourselves this
way, by using supervision, participating in group support
and debriefings to take those stories and work those
stories through. Even if you feel you don’t need
debriefing or group support, I guarantee you, you do. Also, use courtesy when you’re
out there in the team with your group members as well
as with survivors. Say thank you when they do
things for you and try and smile; bring a little bit
of upbeat attitude into the survivor and disaster response
environment, even though it’s a serious place to be. Offsite means when you’re
at home anticipating being deployed or when you come back. If you know that you won’t be
deployed for a while or you come back home and you feel that you
have this need to be involved in some way, look in
your own community. What skills do you have
that can be applied right there with a local agency? Disaster behavior health skills
are not very common and if you additionally have administration
or other skills consider offering them in
the home territory. So actually the
field could be right there in your own community. Now I am going to reiterate here
things that all of us here at SAMHSA and SAMHSA DTAC hope
that you have heard a lot. We think they’re
worth repeating. Self-care begins pre-deployment. It’s not something to think
about implementing after you come back from a deployment. You want to use self-care
skills all the time. You should be engaging
in supervision regularly when in the field. And in most disasters that
usually means daily in some way, even if it’s just touching
base with your group leader. It often means group supervision
on a daily basis or a daily debriefing at some point. And remember that
you have a buddy. Use the buddy
system to help you. Plan together, work together,
talk together, and several times daily you need to engage in
some ways to move stress hormones out of your body. Ten minutes of stretching in the
morning, deep breathing, three or four deep breaths at several
times during each day, and a 30-minute walk at the end of the day with your coworkers or friends are very, very helpful. You don’t have to think when
you are doing these things. The movement alone will help. And remember, talking, having
social supports, helps significantly to ward off
excessive stress. For those of you who like to be
alone at times, music -music that’s timed to the
breath-can help as well. So implement your
self-care on a regular basis when you’re in the field. Ms. Liu: Now April, you know you
and I have a lot of colleagues who are fine in the field, but
what happens when they get home? Dr. Naturale: That’s a really,
really important question Julie. Some people feel more
effects once they are in the post-deployment
phase, once they get home after their assignment. We know that it’s hard for
disaster behavioral health workers to disengage themselves
from the disaster work. But it’s a really
important thing to do. We need to have an end to each
day of work as well as at the end of our entire assignment. So at the end of the day when
you’re taking a walk with coworkers talk about something
other than the work. If you’re troubled by something
that happened bring that into your supervision or
into group support. While it’s good to talk with
colleagues, try to avoid it at times that are meant
to be downtime when relaxation is the goal. And it’s a rare occasion but
sometimes an event or an overwhelming emotional state can
interfere with your ability to carry out your full assignment. Bring these issues to your
team leader and decide together if you need to end early. Don’t make the decision to
stick it through on your own. I always hear that people want
to sign up and go right back into another deployment when
they’re done if there is still an active response going on. It’s highly recommended to take
some time before going back in. Everyone needs sufficient time
to get back to some normal routine, and again, to move
all of that adrenaline and cortisol and the other
stress hormones out of your body over a period of time. If you are home after a
deployment and you still have a lot of energy, that doesn’t
automatically mean you should go back into the field. It more likely means that you
still have a lot of adrenaline in your body, and
that can cause some damage if it remains in excess. As you’ve heard before, disaster
responders can have some of the same symptoms as survivors. Sleep problems are very
common, in addition to headaches and stomachaches. You need to rest, eat
lightly, and avoid alcohol or other mood-altering substances. They really do have an increased
effect and can harm your muscles and other parts of your
body when there are still a lot of stress hormones
in your system. And remember if any of these
problems get worse or don’t go away after 2 weeks,
see your doctor. Sometimes they can check and see
if you had an injury that you didn’t realize happened
while you were in the field. Or maybe you’re lacking in some
vitamins from the stress of the work and the doctor
would be able to help. As you mentioned before, Lori,
when we talk to family members pre-deployment we help to
decrease their anxiety. Well, we have to do the
same thing post-deployment. There are things that your
family should know how to expect what’s going to happen
when you return home. Talk to them about not pushing
you to overdo social activities. While talking to family and
friends is important, you may have some difficulty talking to
acquaintances, people you don’t know very well, or making
small talk, especially in the first 2 weeks post-deployment. Let your family know this ahead
of time so that they don’t plan all of these kinds of events
that require you to participate in ways that you’re
just not ready to in the post-deployment phase. You may think you should do
these things so you might have to lower your expectations
about yourself as well. It would be smarter just to give
yourself a 2-week period of rest to reorient yourself
to routines. That said, this
should not be a time to completely isolate yourself. Some alone time may be good
but too much is not good. Remember, we said that talking
to others is one of the most important ways to
mitigate the development of stress and secondary stress. Reach out to close family and
friends and engage in some low-key activities that you may
like, watching a movie or even just taking a walk together. And you also want to check
yourself, especially a week or so after the deployment -one of
the most difficult things for us disaster responders is to be able to check our own selves. We’re so dedicated and
involved in our work that we always think we’re okay. We give the “I’m
fine” response every time someone asks us how we are. We recommend that you use some
external support to help you. Make an agreement with a trusted
family member or friend that you will respond to them
if they tell you that they think you need some help. Visit a religious or spiritual
advisor, a counselor that you maybe knew from before, or join a support group, or go back to one, AA or NA, something you may have participated in previously, whatever you need to help
yourself stay strong. You can also check yourself with
the ProQOL which is the only test that is specifically
for helpers. Use it before and
after deployment to see if things have changed. The ProQOL helps you to see if
you’re getting satisfaction out of your work, if you’re
suffering with secondary stress, or if you’re in burnout. It’s free and downloadable
at www.ProQOL.org. Ms. McGee: April, we’ve talked
about post-deployment on a personal level but what
about getting back to work? Dr. Naturale: This is
a really important question, Lori, thank you. So many responders tell us that
they are really surprised to find out how difficult it seems
to get back to their regular work after a disaster
deployment. Sometimes it’s hard to see the
meaning in our regular work when we’ve been so
intimately involved in people’s lives in a disaster. We need to remember that a
disaster is a false environment. People respond to us the way
they do because their defenses are down and they’re hurting. We can’t expect that
in everyday life. We need to remember
that everything that everyone does is important. From the farmer who grows our
food to the packager, to the trucker who brings it to the
grocery store and the stock boy who makes sure it’s on the
shelves; everything is connected and we all need each other. We need to remember to value
everything that each other does, all the work that we
do, whatever it is. Ms. McGee: Thank you April,
that’s a good note to end on for all of us just to remember that
the work we do every day is important and not necessarily just those that are doing immediate disaster response. We appreciate your time and your
thoughts on this, certainly hope that it’s helpful to those that
are getting prepared for or regularly experience deployment. Dr. Naturale: Thanks Lori. Ms. McGee: Absolutely. Just a couple of words and a
reminder that this podcast is brought to you by SAMHSA DTAC. Our mission is to support
SAMHSA’s efforts to prepare States, Territories, and Tribes to deliver effective behavioral health response to disasters. We do so in several ways. We provide consultations and
trainings on DBH topics around disaster preparedness and response, acute interventions, promising practices,
special populations. We provide dedicated training
and technical assistance for some of the DBH response grants,
such as the FEMA Crisis Counseling Assistance and Training Program, and we also work on identifying and
promoting best practices in disaster preparedness and planning as well as integrating DBH fields within the
emergency management and public health fields. We have a whole host of
resources including what we call our DBHIS, which is
Disaster Behavioral Health Information Series. These are found on our website
and contain an abundance of themed resources searchable by specific disasters or special populations and different topic areas that we have featured. Finally, we have our
e-communications. A few differences here, which is
the SAMHSA DTAC Bulletin, a monthly newsletter, and it provides resources and events. The Dialogue is a quarterly
journal that we offer comprised of articles that are written by DBH professionals in the field. And then we have our SAMHSA DTAC
Discussion Boards where users can go and post resources
and ask questions of their fellow Discussion Board members. We hope in all of those avenues
we are providing training and technical assistance in
responses to DBH professionals. Here is our contact information
if you have a training or technical assistance inquiry. We invite you to call us toll
free 1-800-308-3515 or send us an email at [email protected]
or if you want to just browse our website and see
what there is to offer we are at www.SAMHSA.gov/DTAC. We thank you for joining us and
listening to the podcast; we hope it’s been helpful and
we thank you for all of your service out in the field. Please feel free to email us
feedback on the podcast or leave that on your registration page. Thank you very much. Announcer:
We also invite you to provide feedback on this podcast by using the link www.SAMHSADTAC.com/
deploymentDBHresponders Also, please visit our website for additional resources, including additional archived webinars and podcasts.

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