A Guide for Emergency Response Workers and their Managers

Although we are two weeks on from the triggering event, engaging in response efforts in the wake of a crisis event like the Canterbury earthquake and the aftershocks is inevitably stressful for those involved in the emergency response. While the work is personally rewarding and challenging, it also has the potential for affecting responders in harmful ways. The long hours, breadth of needs and demands, ambiguous roles, and exposure to human suffering can adversely affect even the most experienced professional. Too often, the stress experienced by responders is addressed as an afterthought. With a little effort, however, steps can be taken to minimise the effects of stress.

Stress prevention and management should be addressed in two critical contexts: the organisation and the individual. Adopting a preventive perspective allows both workers and organisations to anticipate stressors and shape responses, rather than simply reacting to a crisis when it occurs.
Organisational Approaches for Stress Prevention and Management

  1. Provide effective management structure and leadership. Elements include:
    • Clear chain of command and reporting relationships.
    • Available and accessible supervisors.
    • Disaster orientation for all workers.
    • Shifts of no longer than 12 hours, followed by 12 hours off.
    • Briefings at the beginning of shifts as workers enter the operation. Shifts should overlap so that outgoing workers brief incoming workers.
    • Necessary supplies (e.g., paper, forms, pens, educational materials).
    • Communication tools (e.g., mobile phones, radios).
  2. Define a clear purpose and goals.
  3. Define clear intervention goals and strategies appropriate to the assignment setting.
  4. Define roles by function.
  5. Orient and train staff with written role descriptions for each assignment setting. When a setting is under the jurisdiction of another agency, inform workers of each agency’s role, contact people, and expectations.
  6. Nurture team support.
  7. Consider creating a buddy system to support and monitor stress reactions. Promote a positive atmosphere of support and tolerance with frequent praise.
  8. Develop a plan for stress management. For example:
    • Assess workers’ functioning regularly.
    • Rotate workers among low-, mid-, and high-stress tasks.
    • Encourage breaks and time away from assignment.

I compiled this from information issued by http://www.samhsa.gov

You can also download the information from a fact-sheet I developed here.

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The Canterbury earthquake and the effect it may have on families: Part one

People are usually surprised by how much an event like the Canterbury earthquake affects them. It frequently changes the way they think, their values, habits, feelings and behaviour. It influences most aspects of their life. Usually people do not expect their families to be affected as much as they are, but a major event or crisis in the life of one member always influences the family.

People usually underestimate the time it takes to recover from an event like this. Although it is made up of individuals, a family is a unit. What changes one member, changes the others. This also means there is a lot that family members can do to help each other in a time of crisis.

A crisis can also bring benefits to a family in the form of greater understanding, closeness or a new appreciation of each other. It can help to sharpen the focus on what is important in life. Sometimes a crisis can bring difficulties or misunderstanding within families. Family members may not understand each others reactions. They may have to adapt their behaviour to cope with these reactions. It may not always be clear how the feelings and bodily reactions are connected with what has happened, especially if they occur sometime after the event.

Most families overcome these problems when they begin to understand why they are occurring and accept that it will take time to recover. Some of the most common reactions to trauma and crisis are listed below.

Immediate effects

Some reactions may occur immediately after the crisis has passed and continue for some weeks.

  • Spouses/parents may be afraid for their partner’s/child’s safety while away from home.
  • Children and adults may have nightmares or develop fears that a fresh crisis will occur to them, or the family member involved.
  • Family members may be angry because of the fear and distress they were put through; these feelings may be directed at the family member involved, at each other or at people outside the family.
  • Family members may lose trust and confidence in themselves and other people. The world may no longer feel safe, their own welfare may seem uncertain, everything may seem too difficult to manage.
  • Children express their insecurity by naughtiness, bed-wetting, changes in eating and sleeping habits, tearfulness and irritability,  or reverting to behaviour they have grown out of.
  • Emotional turbulence, anger, guilt, sadness, unpredictable behaviour or unreasonable reactions may occur in any family member.
  • Communication may be difficult because family members do not know what to say to each other, or they do not feel like talking.

In my next post, I’ll write more about medium and long-term effects and what you can do to help.

More on supporting children through the earthquake, aftershocks and adjusting to life

Last week, I posted a quick entry to help orient you to some of the ways that children may be experiencing the earthquake, aftershocks and life after the quake. It will certainly never be the same. Even if there is potential for growth and gain through this in the medium-to-long term, it will certainly be different. And for most, the current situation is probably disorienting and confusing – as we try to make sense of what has happened, and what will happen next.

Children have their own ways of dealing with crisis according to their stage of development. Often their response is not what may be expected and may not show up for some time. Parents and others often worry and frequently are not sure of the best way to help them. Today, I’m posting more detailed information on how children tend to react to experiences like this, their likely needs, and how you can help.

The family

The family is the most important part of a child’s life (this changes for adolescents – see my advice sheet here). Parents give them their security and confidence. What trauma means to children depends to a large extent on how their parents react to it. Often this is more important than what happens to the children themselves. Parents can help their children by sorting out their own reactions and feelings. Do not be surprised if children’s reactions seem out of keeping with their experiences, they may be reacting to family members’ distress. Children (even infants and toddlers) always know more than adults give them credit for. They are aware of many things they cannot put into words for us. Children think about things a great deal even when they are not talking about them, but they can only put them in perspective with adults’ help.

Children need to make sense of things that happen. Children often don’t have all the facts and their thinking is not yet mature so they use imagination to fill the gaps. Often this results in misunderstandings, which they may keep to themselves, especially if they are frightening. What they imagine is usually more frightening than what really happened.

The child’s experience

Don’t assume that you know what the child understands about the earthquake or aftershocks, but find it out by talking and listening to the child and observing their behaviour. According to their stage of development, children may only take in some aspects of the situation. Their understanding is often limited, fragmentary or even distorted.

Reassurance is important, but does not help until the child has an accurate idea of the event and its causes, and their misconceptions have been corrected. Parents also need to find out what reassurance the child needs. This is not always what children ask about at first.

When someone they know is involved in a crisis, children may be distressed and imagine how it would have been for them to be involved in the crisis, but they usually express these feelings indirectly. They may feel their own security is threatened and that it could happen to them, however unlikely this may be. Sometimes, the crisis makes it harder to deal with other ordinary problems. Children don’t usually tell adults about these things because they may feel too self-conscious, are afraid or can’t put them into words. This can lead to misunderstanding or conflict between adults and children.

Children’s reactions may appear at the time of crisis or later. Sometimes they manage very well when the trauma is in everyone’s mind and only later start to worry, become difficult or feel as though they cannot handle their responsibilities. It can take months for things to build up to the point where parents or teachers realise a child may be having problems or needs extra help. By this time the event may seem less significant to adults. It is common for children to hold back their own needs and difficulties until they sense their parents are over the worst, and it feels safe for them to relax and start reacting.

Children’s reactions

These are some of the changes that can be seen in infants and children under stress:

  • sleep problems, nightmares, reluctance to go to bed or get up
  • changes in dressing, eating and toilet habits
  • irritability, uncooperative, listless or bored
  • clinging to family or familiar things, needing objects for security
  • unable to cope with change or ordinary problems
  • reverting to immature behaviour or habits they had previously grown out of
  • changes in relationships with parents, becoming more demanding, possessive, withdrawn, or uncommunicative
  • relationships with brothers, sisters and peers become more difficult. Often there is an increase in conflict, competition, aggression or withdrawal within these relationships
  • preoccupation with the trauma; wanting to talk about it, playing it out, wanting to see where it happened
  • excessive concern for others; holding back their needs to protect adults and anxiety about loved ones
  • reduced school performance, concentration or ability to play constructively
  • overactive behaviour, restlessness or dissatisfaction
  • small ailments or injuries are exaggerated or used to get comfort and security
  • transitions such as from preschool to school may be more difficult. Often there are problems at the start or end of daily activities
  • exaggerated reactions to small crises. This may be an expression of their distress about the incident which often they don’t fully understand.

How to help

  • It is better to tell children what has happened. Giving them the facts (but without unnecessary detail) helps prevent their imagination taking over.
  • Encourage them to express emotions. Fear and sadness are their way of coming to terms with what has happened. Hold them or stay with them, offer support while they are upset and then talk about it afterwards.
  • Keep communication open by asking questions to find out what they are thinking or imagining. Tell them how adults feel and what the actions of adults under stress mean. This will prevent children blaming themselves.
  • Reassure them about the future, especially the small details of life which are such an important part of their world.
  • Encourage them to continue to be children, to play, explore and laugh when they want to, even though the adults may not feel like it. Children are often able to take their minds off the crisis and its effects better than adults.
  • Maintain routine and familiarity to help children see that life is secure and predictable.
  • Reduce change of any type to a minimum. When change is necessary, take time to prepare children for it.
  • Keep them informed of how their recovery is going and what to expect.
  • Don’t make this the time to correct bad habits, don’t overreact to unusual misdeeds or bad behaviour. Talk about the behaviour with the child; they may need to let their tension out somehow.
  • Give children time to sort themselves out with your support, don’t expect it to be over quickly.
  • Keep track of the child; remember what she or he does and says, try not to let lasting changes in temperament and behaviour creep up without noticing.
  • Make time for just being together. Take time out and reestablish recreational activities and outings as soon as you can. Pleasure is an important part of healing.
  • Re-involve the child in chores and responsibilities as soon as they are ready to cope with them again.
  • Take seriously all their concerns, complaints and questions. They may be trying to express something important which they don’t have the right words for.
  • Parents need to get support to work through their own reactions, so they can help their child.

Summary: Brief Tips for Parenting after a Disaster

Be a caring parent.
Parents and guardians play a major role in ensuring the safety and well-being of their children. Although you may be under more stress after a natural disaster, it is important to continue caring for your children. Children are strongly affected by your reactions.

Keep your children safe.

You must know where your children are and who they are with at all time.

Establish routines.
Establishing new routines is especially important when normal ones are disrupted. If you are in a shelter and unable to return home, establish routines such taking a family walk, eating meals together, or reading a bedtime story.

Take a time-out.
When you feel overwhelmed, take a time-out. Take a few deep breaths, count to 10, or take a walk alone.

Ask others for help.
Ask trusted friends, family members, and other parents for help if you feel overwhelmed.

When to seek help

The best gift you can offer children is understanding. Don’t hesitate to seek advice if you do not understand any aspect of your child’s behaviour or if you have any concerns. A little help early can save a lot of heartache.

I have adapted from information issued by http://www.samhsa.gov and Queensland Health: Fact Sheets for Psychosocial Disaster Management. This information is also available on a fact-sheet I compiled for the Ministry of Health.

Checklist: Common reactions, positive coping, and when to seek help

A new week is with us. So, here’s a heads-up.

Distress is an understandable and normal response to major disasters. Common causes of distress may be related to having been directly at risk from the earthquake and aftershocks, being concerned about family and friends who may be affected, witnessing injuries and distress to others, or being caught up in the panic and confusion that often follows. In addition, feelings and memories related to previous experiences of disasters or other grief and loss may also resurface. Most people experience acute stress during emergency events and most manage with courage and strength. However, sometimes it is only later when the distressing images are recalled that some of the stressful effects start to show.

While most people will manage with the support of family and friends, there are times when extra help and support may be needed. Those who have feared losing loved ones, have been seriously injured, or are highly distressed by the aftershocks, will often need particular support and care. Our communities have a history of coping with uncertain and troubled times with courage and strength.

There are three important things you need to know:

  • normal reactions to this type of emergency
  • positive ways of coping
  • when to get extra help.

Normal reactions to a disaster like this include:

  • shock and numbness, often fear at first
  • horror and grief when the extent of loss is realised
  • frustration, anger, helplessness and even sometimes despair when it all seems too much
  • sometimes fears or old worries may resurface.

These feelings usually settle over the early weeks.

Positive ways of coping may be:

  • supporting one another, especially in the family and in your community
  • providing emotional support – comforting each other
  • carrying out practical tasks – tackling the jobs that need to be done a bit at a time and counting each success
  • sharing your experience and feelings with others – a bit at a time when it is right for you
  • looking after your own and your family’s general health – rest, exercise, food and company all help (being careful not to drink too much alcohol).

Sometimes, post disaster stress can be ongoing and affect your physical and mental health and wellbeing.

It’s time to ask for help if:

  • your sleep is badly affected
  • you feel very distressed, irritable, on edge or agitated much of the time
  • you feel hopeless, despairing, miserable or that you can’t go on
  • you have trouble concentrating, are distracted and cannot do your usual tasks
  • you feel your health is not so good
  • you have recurrent nightmares or intrusive thoughts about the earthquake
  • you have new symptoms or old problems may seem to have returned, eg. breathing, heart and stomach problems.
  • For children, withdrawal, aggressive behaviours, difficulties at school, problems separating from parents or going to sleep may indicate the need for help.

This is just the brief version. If you want more detail about specific topics, check out the other posts on this blog. The home page will have a list of recent posts in the right-hand column. Or you can click here for the fact-sheets at the Ministry of Health. I compiled these too.

Helping adolescents through the Canterbury earthquake and aftershocks: Part One

One week on from the initial earthquake, and hundreds of aftershocks later, it is the weekend. A chance to take stock of what will be remembered as an unforgettable week for a generation of New Zealanders, with considerable uncertainty about what may be yet to come.

But much of the Christchurch CBD is accessible again. All over the region, people will be out and around, surveying their surroundings. Some will take the opportunity to re-connect with others, while others will perhaps take a moment to consider their journey so far, and what they might do next.

One group that can often suffer a little from the lock-down that tends to happen during emergency events are adolescents. All sorts of stuff going on in the life of a modern adolescent – family competes for attention with peer groups, cellphones, games consoles, and generally being out and around and exploring the world. However, under the threat of earthquakes and the aftershocks, people are sometimes enforced to spend a lot of time indoors and in cramped spaces. This weekend might provide a bit of release.

Adolescents involved in crisis and emergency events, may not always show their distress outwardly. As a result, adults may misunderstand their needs or find them unwilling to accept help. Adolescents frequently lose the self-assurance they had when younger, but often gain other types of confidence and abilities. Parents, and adolescents themselves, are confused by their inconsistent behaviour. They can think rationally, but have unstable emotions and may not apply logical thinking to real situations. They need support and independence to learn this. They want to be both close to others and time to be alone as they find new ways of relating to people. To communicate with adolescents, these contradictions have to be understood. Moodiness, depression and insecurity commonly alternate with excitement, happiness and adventurousness.

Whereas children are dependent on parents and live within the family, adolescents are usually proud that they could survive on their own. School, peers, other adults and social or sporting groups are a large part of their support network. They often do not feel the family is the life support system it was in childhood. Parents may feel sidelined, but their importance is no less than before, just different.

Adolescents usually don’t understand these changes although they feel the frustration of them. They need their family to be a trusted home base for their adjustment to painful events, but how much they rely on their family to come to grips with what has happened varies greatly from one person to another.

Adolescents are often more involved in doing things than understanding emotions and may lack words to express important feelings. They handle painful events by distracting themselves. They may be immersed in their own feelings and point of view and not recognize adults’ reactions. They may feel threatened when adults try to be logical about painful experiences and not fully understand what is said until later. But their behaviour often shows they have taken notice even when they don’t acknowledge it. It is important to allow time for them to work things out and not demand immediate feedback. Parents’ own anxiety may make adolescents confused and guilty or cause them to reject the parent’s emotions to protect themselves.

Jump down to Part Two of Helping Adolescents for more.

Helping adolescents through the Canterbury earthquake and aftershocks: Part Two

Continuing on from Part One of this topic, I could talk about the influence of peer groups and all sorts of other things. But, for now, I’ll cut to the chase. Here are some of the behaviours you might see from adolescents as they come to terms with their experience of being under threat with the uncertainty this involves:

These responses are all signs of the stress of coming to terms with crisis. They are normal reactions to abnormal events and should pass with time.

  • excessive concern for others, guilt, anxiety and insecurity
  • sleeplessness or wanting to sleep all the time
  • withdrawal from family, spending increased time alone listening to music or watching TV
  • wanting to be around the family more than before or more dependent on family or other people
  • sudden need for independence expressing feelings like ‘don’t treat me like a child’ and ‘you’re only my Mother’
  • uncooperative, irritable and only concerned with what is important to them
  • bored, listless and dissatisfied unable to cope with responsibilities or duties, reverting to immature or irresponsible behaviour
  • preoccupation with the trauma, wanting to talk about it all the time – or angrily refusing to talk about it
  • more detached from life, the future or interests, and an unwillingness to set goals
  • want to do everything now: they are impatient or intolerant
  • pessimism and cynicism, loss of interest in the future
  • changed values and philosophy of life poor concentration, memory, organisation, planning skills and reduced school performance
  • restlessness, always needing to be doing something or be with peers
  • exaggerated emotional reactions to small problems
  • angry, controlling, assertive and demanding
  • exaggeration or return of previous problems.

If some of this seems contradictory, welcome to the world of adolescence.

Here’s how to help:

  • Give them accurate information about the event and its consequences.
  • Correct any misunderstandings and rumours, but do not burden them with details unnecessary to the overall understanding
  • Encourage them to express emotions and put thoughts into words—if not with you, make sure they talk to someone. Give them the opportunity, but let them go at their own pace.
  • Expressing strong emotions is a natural way to come to terms with crisis. As the emotions subside recovery starts.
  • Suppressed emotions can cause long-term problems. But there are many ways to express, not just through talking.
  • Keep communicating, if they won’t talk about emotions, ask the adolescent what they are thinking.
  • Let them know about your reactions, explain about stress and recovery. Even if they don’t admit it, they do take in what is said
  • Keep telling them you love and care about them no matter what they do or say.
  • If they object to what you are doing, don’t argue, ask them how else you can help.
  • Reassure them about the future, especially that their current distress will pass in time.
  • Make plans to reduce pressure at school or in other activities if they are having trouble coping.
  • Support them to continue their social and recreational activities, to play, explore, laugh, even though the adults themselves may not want to.
  • Maintain routine and familiar activities, ensure life is secure and predictable; minimise change.
  • Keep them informed about how their recovery is progressing and what help is available.

Don’t make this the time to have disputes about normal problems such as work, chores or defiance. Leave this for later or it will be confused with the crisis reactions. The problems usually fade as adolescents recover. If not, the problems will be more successfully worked out later.

Adolescents’ striving for independence, seeking help from peers and adults other than their parents and expressing critical attitudes are all indications of parents’ success in giving adolescents the strength and confidence to become adults. This behaviour needs to be valued and worked with rather than against.

Sometimes, adolescents have a narrower point of view and can accept the earthquake and all it entails in a matter-of-fact way. They may not need their parents as much as parents need them. When this happens parents must continue to be available, but in a different, more detached way and avoid burdening adolescents with their own distress as much as possible.

An event like this also provides adolescents with opportunities for growth and discovery about themselves. With help, adolescents can eventually mature as a result of the experience. They often show strength and resilience that has not been evident before.

Prime Minister John Key gives good counsel

I think Prime Minister John Key made some very helpful statements yesterday regarding how some people are reacting to the earthquake and subsequent aftershocks and how they might get help. Here is some of the quote:

Prime Minister John Key is calling on those still residing in Canterbury to consider seeking counselling to deal with the stress of the earthquake and continuing aftershocks.

Speaking to RadioLIVE’s Marcus Lush this morning Mr Key said that the “compounding increase in anxiety that is taking place because of the aftershocks” only became clear to him upon visiting the region to assess the fallout of Saturday’s quake.

“People are living in slightly damaged houses, so they’re thinking ‘I’m living in a damaged structure, I’m fearful of another earthquake’ and of course they’re getting really upset, and that’s really one of the reasons why we’re asking people to reach out and get some counselling,” said Mr Key.

Do you notice how he doesn’t talk about trauma?

He talks about anxiety and getting really upset.

Mr Key is getting good advice (or he knows this himself, possibly).

Talking about trauma is not very helpful, and it is not true for the majority of people either. In this post, I point out how research predicts that most people who are living through this unfolding event will be OK. They may have some ups and downs and some wobbles along the way, the dominant story is resilience for the majority, particularly if they have supportive friends, families, clubs , societies, church groups, and voluntary or government-sponsored groups standing strong beside them. Trauma symptoms affect the minority but we of course need to ensure that we can identify and help these people early on in the piece.

Mr Key gets this.

Talking about trauma turns people off from looking for help. However, anxiety and uncertainty will be all too common. This is just a normal reaction to a highly unusual and sometimes frightening set of events. Getting good information about why people are feeling, thinking and behaving like they are, that they are not alone in experiencing this, and that there are concrete things that can be done, along with caring, compassionate people (sometime professionals) around to help them work through what they need to do – this is what Mr Key is getting at.

People to hear their story, when they’re ready.

At their own pace.

Those people are around – you might already know them.

Just don’t let anyone rush you.