Aftermath…Planning
for the Long Term
Once the crisis or disaster
is over, evaluate your response efforts and make adjustments to your
disaster plan as appropriate.
Often the real work of a mental
health center begins after a crisis or disaster. Helping individuals
and communities recover requires outreach, public information, and in
some cases establishing a crisis center or new program. This checklist
provides guidelines and considerations for the long-term response to
a natural or manmade major disaster.
When you’re
setting up a team
Hire your team manager
first and give them the responsibility to build the team. Consider
someone from outside the organization who has experience in treating
victims of trauma and can bring a fresh perspective. Depending
upon the nature of the event, many staff in your organization may need
a break.
Recognize the potential
for high levels of turnover. Having staff for a short period of
time, which they know from the beginning, can be difficult, as they
look for jobs from the beginning of service. As they may start
to burn out, they leave, and other staff come on and rejuvenates the
team, but this may upset the team equilibrium.
Spend time with
administrative setup. You may need more staff for administration, contracts,
human resources, financial support, overseeing community outreach and
evaluation support.
Provide support
to the team leader with an experience administrative person from your
organization that understands how to get things done in the organization.
Assign responsibility to this person for playing a key role in the administrative
aspects of recruiting, screening and hiring the remaining team members.
Depending upon the
event and team focus (and possible duration of team), some positions
will not require a mental health background. Consider hiring people
who know the community well.
Hiring for
high trauma events
Hire experienced
people.
Ask candidates about
experience with trauma, theoretical approach to trauma, experience with
target populations, approaches to team consultation, willingness to
accept supervision, and resources in private life.
Set ground rules
from first interview; short-term appointment, ongoing evaluations for
Vicarious Trauma, possible effects of working with mass trauma, compulsory
attendance at team meetings. Plan for the end from the beginning;
everyone is going to be evaluated for Vicarious Trauma every six months,
including the team leader, and it’s not going to affect his or her
performance evaluation.
To ensure that all
staff have the same knowledge set, provide them with an orientation
packet of information that includes a list of articles particular to
disaster and trauma.
Front desk/triage
person critical hire; has to be soothing, discerning, capable of making
rapid decisions, ability to call for help when necessary.
Screen carefully
for zealots or individuals with trauma histories that may impact current
role. People
will quit their jobs, drive cross-country, and show up at your door
to be part of the effort.
Set up systems in advance
Team leader/project
director sets up debriefings; team meeting protocols, supervision times,
policies and procedures.
Team leader/project
director coordinates with advisory committee, umbrella agency if a collaborative
program and the community. You want to have an advisory committee
from the community for advice, buy-in, and oversight. Keep in
close contact with your umbrella agency.
Make sure you have
emergency procedures set in place and that security issues are covered.
Paperwork can be
an issue at a crisis center or trauma treatment program. Consider reducing
paperwork requirements for disaster team when possible.
Set up mechanism
for credentialing outside referral sources.
In your own system,
recognize that for this particular team you may need to alter Human
Resource policies regarding time off, vacation time, and leave time.
Establish Human
Resource policies for removing workers by Vicarious Trauma.
Let your clinicians
know about the opportunities for personal psychotherapy afforded by
their insurance plan.
Do system-wide training
on trauma, Vicarious Trauma, suicide, mass disaster, and debriefing.
It’s important to acknowledge that the whole system may be impacted
by the disaster, not just the team.
Keep in touch with
the executive team of your organization to let them know what's going
on at this community based program site. A monthly report can
be helpful.
Set up a way that
the organization can support you in what you're doing. Have your
supervisor monitor you for Vicarious Trauma, time off, and use of supervision.
Operating the team...Risk
Management
Distribute a media
guide to all clinicians. Request them not to speak to the press
without informing you or the media officer.
Insist on client
lists, with severity and lethality ratings, every week. Rotate
the duties of too heavily burdened clinicians.
Insist on a mandatory
medical evaluation for all clients diagnosed with moderate to severe
depression or aggressive tendencies.
Do not allow the
inside of the treatment/outreach center to be photographed.
Monitor clinicians
for Vicarious Trauma/burnout level. Address it.
Establish a procedure
for reporting abuse/neglect.
Establish a policy
regarding whether the treatment/outreach location will continue to see
clients who are hospitalized for suicidal ideation/attempts. Let
clients know this policy up front.
Develop security
procedures immediately. Consider putting in a "panic button".
Try to find a group
of outside clinicians you trust to refer clients to. Always give
three names.
Know the names of
substance abuse treatment centers and residential centers that specialize
in trauma.
Know which clients
are in crisis and the plans for them. Print cards giving clients the
numbers of crisis services. If possible, call the crisis service
and give them a heads-up.
Many severely traumatized
clients have memory problems. Tell troubled clients that the center
policy is to do welfare checks on clients who do not show up and do
not call for regularly scheduled appointment.
Do not refer on
fragile or suicidal clients until they have stabilized.
Ethical Issues in Crisis
Memoranda of understanding
are important. It is easy to violate confidentiality of client
without them. Schools and police have a natural sense of urgency regarding
your clients. Violating confidentiality can seem less severe in
times of crisis. It isn’t to the grievance board.
When working with
schools or the police, remember that the agencies’ desire to know
does not supercede the clinicians' duty to safeguard the confidentiality
of the client.
Boundary violations
occur more readily in tired, stressed, overworked mental health workers.
Violated people
can violate others. Be aware of the harm your clients may cause.
Rates of domestic violence, suicide, and homicide rise in the wake of
trauma. Be sure your clinicians check.
Be sure to have
your clinicians check for pills, knives, and guns in the home and document.
Support the Long Haul
Have your organization
recognize and praise the people on the crisis/disaster team for their
work.
Provide job finding
or disability insurance help for people who need to be removed for Vicarious
Trauma.
Let your community
advisory board know about what you're doing. Other community agencies
can be called in to assist you when necessary.
“Buddy up"
with another community agency. Let them support your crisis/disaster
team.
The
Red PagesAftermath
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