 Alright, hello everyone. This is Jess Unger here. Thank you for joining us for today's webinar. This is of course the first in your eight-part series to complement the in-person training for the Texas Heritage Response Team. These programs are made possible through the generous grant funding support of the Andrew W. Mellon Foundation. We're kicking off this webinar series with three programs that take a broader approach to the topic of disaster response. Just going to pull over for you all here, a reminder of the overview of our webinar schedule. Today's program, of course, is on the Psychology of Disaster Situations. We'll be holding our next session on March 7th regarding health and safety, and then we'll be holding another session on March 21st about funding sources for cultural institutions affected by disasters. From there, we'll move into programs that address material specific salvage considerations. Photos on electronic media, textiles, wooden and upholstered furniture, paintings, and book and paper objects. We'll wrap the final program on May 23rd, which would be just about one month before our final in-person meeting and disaster scenario training. If you miss any webinar sessions, I'll email you with a recording of the program. Write to me when you finish with the recording, and then I'll note your attendance. You will be expected to complete all webinars before we meet again on June 21st. Before we begin today's presentation, I wanted to share some brief technical notes. On your screen, you'll see several boxes including one labeled chat on the left-hand side. You can use this chat box to say hello, ask questions, share any information or links that you'd like. Links will be live, so all attendees can click directly on them. If you post a question in the chat box, you'll receive a response from me. Any questions will be noted, collected, and then I will verbally ask them of our presenter when she completes remarks. You'll also see a box at the bottom of the screen titled Web Links. Simply click on one of these links to highlight it in blue, and then click the Browse To button at the bottom of the window in order to open that page. And with that, I'm very pleased to introduce you all to today's presenter, Dr. Jody Hortsman. Dr. Hortsman is a PhD, HSPP, and a licensed psychologist. She has 28 years of experience in community mental health, serving youths, adults, and families. In her current role at Aspire, Indiana, she serves as Chief Clinical Officer. Prior to that, she served as Senior Director of Comprehensive Outpatient Services and Senior Director of Youth and Family and Community Services. Since 2005, Dr. Hortsman has taught courses on psychological first aid with the state of Indiana. She has been involved with multiple disaster mental health responses, both nationally and internationally. She served with the American Red Cross in New York following September 11th as part of the Indiana Task Force that assisted Mississippi following Hurricane Katrina, and worked in Haiti following the 2010 earthquake. She is a member of Indiana's state disaster mental health team and a trainer of psychological first aid, PFA. Dr. Hortsman received her Bachelor of Arts degree in behavioral science from California State Polytechnic University, and her Master of Arts and Doctoral Degrees in clinical psychology from the United States International University in San Diego, California. Dr. Hortsman was involved with training the team of national heritage responders on the topic of the psychology of disaster situations. So we're incredibly fortunate to be joined by her today. And with that, I'd like to turn things over to Dr. Hortsman. Thanks, Jessica. I really appreciate the introduction and I appreciate the opportunity to be here today. Looks like we have quite a few participants, so that's that's exciting. I always welcome the opportunity to talk about this. So this is this is not my day job. I work at a community mental health center, but this is truly my passion is disaster response. So thank you again for for letting me participate in this. So I am going to drive the presentation today. I do want to note that I have included some photos in here. I know it's very dry to sit and watch a webinar and hear someone talk and not be able to look at things. So I'm going to try to punctuate this with some photos and some stories along the way. So let's talk a little bit about what we're going to talk about. So I'm going to talk a little bit about disasters in general. And then the impact or consequences of those disasters. The focus of today is going to be providing some background information related to that some general understanding of those that impact and those consequences, understanding some of the special needs of certain populations. And then what are the needs of the survivors and responders. And then we're going to move into psychological first aid and a little bit about self care. So let us begin. Alright, so I'm going to start with a slide that may seem odd to start with, but it's really about resilience. Because resilience is really important here and is often underestimated. So when we hear about a disaster or a traumatic event or, you know, widespread impact of something negative. Oftentimes, we are led to believe that that this is an absolutely devastating event that everyone is severely negatively impacted. I'm going to talk a little bit about why we're led to believe that. But what is often not noted, and isn't, I guess, maybe felt to be attention worthy, is that really resilience or that ability to bounce back to maintain a stable equilibrium or to better cope with things negative events in the future is really more common than we believe. Now, I'm a psychologist. And so the second point here has been true for me as well. So mental health workers, we typically often don't appreciate that. And actually in the past decade or so, this has been a focus that's been pointed out to us is to recognize people's strengths and to not make assumptions that because something negative occurred that people are going to automatically, say, develop post traumatic stress disorder. It's actually much more common in both children and adults for people to respond in a resilient manner. And we think of resilience often as something that is kind of innate to someone like you may say, oh, yeah, he or she is just a very resilient person. But really, only 20 to 30% of our resilience has to do with our genetic or biological makeup. It's certainly impacted some by our early upbringing and exposure. But by far, resilience is mostly related to a series of skills that can be developed at any point in our lifetime. And some people have done a really good job at developing those skills. Others have some great opportunities to develop those skills. But the great news is that we any of us can do that at any time. So I have a statistic on here, it's fairly old that 50 to 60% of US population is exposed to traumatic stress. I recently actually just read another one that says really about 85% of adults in the US have been exposed to some type of traumatic event. But bottom statistics remains the same that really only about 5 to 10% develop post traumatic stress disorder. We as a country have been very sensitized to that diagnosis. Due to military conflicts and our armed forces coming back home, and that's certainly not to minimize that some some individuals may be experiencing that. But because of those conversations, we often jump to the conclusion that any exposure to traumatic stress will automatically lead to some serious consequences or potentially a diagnosis. And that simply is just not true. Okay, so let's talk. Actually, you know what? I'm going to go back a little bit and do. Let's stick with this. Okay, so consequences of critical events often include loss. And that by itself makes sense, right? But what we don't often anticipate is that those those losses are really beyond what we would imagine at any given point in time. So for example, we may say, Well, if if a disaster occurred, so here I am in Indiana, if a tornado came through, then and and I lost my home, then I would be able to access these resources or I would be able to be able to stay in a hotel or I would be able to still go out to a restaurant. And and oftentimes we just really don't anticipate all the different ways that that impact that a disaster may impact us. So I'm going to go through some of those. The important thing here is that every day we function with a level of denial. And it's a very healthy level of denial. So for example, we wouldn't get in our cars and drive if we were very focused every day in terms of what the risk is or what the statistics say in terms of our risk of being in an accident or being injured or being killed. So in actuality, we kind of put that out of our mind, right? Same thing when we get in an airplane. So we take those risks and we set those aside so that we can function on a day to day basis. And what happens in a disaster is that that that is stripped away from us that sense of safety and security that we base our everyday lives on drastically and abruptly get stripped away from us, leaving us questioning a lot of things and feeling very vulnerable to a lot of things. So these critical losses that we may experience could include our loved ones, certainly material goods, so you know, the things that we own, but also some real systemic or community type resources. So our employment, most often people don't think of the impact of a disaster is I may lose my job or my employer may no longer be functioning in that community. And again, trust in the future. So I'm going to show you some photos from Katrina. So to illustrate this point. So here's a photo of a church in the aftermath of Hurricane Katrina down in Gulfport and Biloxi. And so when you think about where do people go when they feel like they've had critical losses or they feel like they're lost or questioning where there's those sources of support that we would traditionally and habitually turn to. And certainly our religious faith, our spiritual connections, that sense of community through our faith organizations is one of those that's frequently turned to and may no longer be there. When we were deployed to Biloxi, this was a comfort suites motel that was very close to us. And again, back to a previous comment. So your home is flooded or destroyed in a fire. And you are assuming that you'll have another place to stay. Well, as we know, when there is widespread flooding for devastation, that that may not may not really be an option. But we don't really think about that at the time. We also typically don't think about how we're going to get around. We make assumptions that I'll be able to drive to Walmart, or I will be able to get to the bank. I will be able to exit this area and go somewhere else. And the reality is that we may not have access to that transportation. And again, on a day to day basis, that's not something that we even consider. This was a Windixie. When I was down in Mississippi, this was probably one of the biggest surprises that we as responders faced is that we got there and there was nothing. There was literally nothing. There was no access to getting material goods. There was no electricity. There were no cell phones. The water was contaminated. People had been faced with this. The people that reside there have been faced had been faced with that for some time. But that infrastructure was not there. And we base our day to day assumptions again on that. Another piece of infrastructure that I'd like to bring up that I learned about while I was there was banks. So I'm going to encourage everyone on a day to day basis in preparation for the unexpected is to carry out what we call a flying 40. And a flying 40 is that you have some cash $40 $20 or whatever that you keep in your car or a safe place or some amount of money in small bills. Because what we saw there and I'm sure also impacted areas with widespread flooding was that banks were not open. There was no electricity. And when they did open, they had limited cash. And so we would see long lines of folks that were waiting for $20 because that's all that there was a certain amount of $20 bills that were going to be passed out from the bank that day. So even when Walmart, which is traditionally the first store that does open after disaster, I have to give them a lot of credit. They have they have quite a plan and procedure to getting getting goods into a disaster area. So even when things did open, people did not have money to be able to purchase things. And of course one of the the other great impacts in in a flood or hurricane are impact to rituals. So some of those are related to cemeteries. So one of the things that occurred there was cemeteries were flooded. Remains were swept away. They were mixed up. They were lost. And there's a some real critical loss that's also felt with that. So let's let's talk a little bit more about some definitions. So we talked about resilience to begin with and now let's talk about a crisis. So here you have one definition of a crisis events or situation perceived as intolerably difficult that exceed in individuals available resources and coping mechanisms. And so what I what I want to point out to you and why I have this slide on here and why I'm going to differentiate this from trauma or disaster is crisis is very unique. And we as human beings can tend to be a little judgmental sometimes. So sometimes we will meet people who will be experiencing something and will in our minds say to ourselves I just don't understand why this is a crisis. It wouldn't be a crisis to me. So but it's also very important because as you are interacting with folks you don't know. You don't know what what stress they brought to the table. What burdens they were already carrying before this particular event occurred. So for example if I am already going through a divorce and maybe I'm losing custody of my child or I've lost my job or my home is in foreclosure and then this occurred it's almost as if I'm already at simmer and it's not going to take a lot of stress to bring me to boil. So a small event may be perceived as a crisis to me at that point in time just because I am so strapped for resources and feeling unable to cope with what's occurring at that time. So my message here is be compassionate but also be aware where are you in terms of your stress level when you're asked to respond or deploy to an area. What resources do you have available to the table to bring to the table and how will that impact you. I also want to talk about a disaster. So a disaster is a sudden calamitous event that seriously disrupts the functioning of a community or society and causes human material and economic or environmental losses that exceed the communities or society's ability to cope using its own resources. So that definition you can tell is much broader much more impactful in terms of its impact but many of the same concepts here in that a community or a society's available resources are inadequate to cope and they feel overwhelmed. I also want to briefly talk about a couple other terms. So we use a term survivor. We don't tend to use the term victim because that that has a negative connotation and survivor is an individual who's been directly impacted by the event. So what I really want to point out to you is that a responder a responder who goes to that situation who participates who is assisting in that situation by definition even though they are there to help or support because they are there they in essence are also a survivor. So a lot of the things that we talk about as we move forward I want you to think about in terms of okay so there's individuals that were directly impacted when it occurred but by virtue of being there and participating and assisting you also are subject to many of these same types of issues or concerns and then there's trauma and trauma is not an event. Trauma is actually a process and this is where the psychological first aid will come in later as we're talking about the impact of trauma. It is very unique again to the individual. It's the individual's perception of the event. It is not an objective definition. It is it resides actually in the nervous system and in the body so the bottom portion of the slide it happens when an event stuns like a bolt out of the blue overwhelms the individual and leaves us altered and disconnected from our bodies and what that basically means is that the suddenness the stripping away of that sense of safety and the resulting thinking and emotions that go along with that really impact us on a biological level. So we say trauma resides in the body as opposed to that it's a cognitive or emotional issue because we experience very strong emotions very disconnected sometimes disconcerting thinking but doesn't necessarily seem very logical and rational to us as a result and is worrisome and we'll talk a little bit about that so we we can't understand it we can't make sense of it and that is part of what psychological first aid does is to help us kind of categorize that and tuck that away. So let's a little talk a little bit about the psychological consequences of disaster. So let's talk first about psychological footprint when a disaster or broad spread event occurs what we typically hear about are deaths, injuries and economic losses. What we don't typically hear about is psychological impact and that may be because it's hard to define and because there does remain stigma related to that 9-11 I think was a groundbreaking in terms of allowing us to normalize people's reactions to abnormal situations to be able to seek assistance or ask questions about what we're experiencing and there's since that time we really have a come come a long way but it's usually responders that are more in tune with the psychological footprint so this photo or this picture here is basically a representation of the impact so if you look at it the small blue circle is the medical footprint of that disaster so that would be the injuries or that would be the the deaths and then you see how small that is compared to the psychological footprint so let me give you an example of this a couple different examples so let's say that a tornado comes through town and while school is in and knocks out cell towers cell towers um where and and schools are evacuated and people don't know where their children are where is it that they go where is it when we can't find someone we're concerned about and there's been some devastation or some type of disaster event where do we go we go to the hospital and so we call this the psychological surge of a hospital this is where people will show up at the hospital looking for other people will ask asking to have their questions answered they um to use the clinical term maybe freaking out right it's not really a clinical term that put their quotes around that but that's kind of that's kind of what we say right I mean people are very concerned they can be panicking and they're they they need attention and it's not unreasonable for them to to feel that way however their psychological or emotional responses oftentimes do get in the way when when there is medical care that needs to be given or there is triage that's going on so that's how a psychological footprint can immediately impact the situation and also tends to be much more long-standing here's another example if you think about after 2001 excuse me to the anthrax scare and you think about how many individuals were afraid or didn't want to touch their mail or you know were their anxiety peaked related to exposure to anthrax and then how many direct casualties what there actually were there were 22 direct casualties related to anthrax yet it it totally shut down our our postal service and people were again very concerned very freaked out very reactive to any type of white powdery substance and so if that's a good example of medical to psychological ratio in terms of the impact this is a picture from Haiti following the earthquake and part of why this is here is to talk a little bit about infrastructure because again the impact is widespread and oftentimes not what we anticipate so because some disasters are very widespread and certainly the flooding from the hurricanes and if you think about the wildfires that have been occurring you know that's a lot of territory a lot of infrastructure a lot of economy and a lot of lives affected and so we often think about again in that typical day-to-day living-your-life kind of thing oh yes well if this happened I'll rebuild my home or I'll do this and maybe that those resources aren't there and we'll get into that a little bit about our expectations and how that impact us but again that sense of security that sense of the way things should be the way they ought to work get stripped away again in Haiti so this is trash this is garbage that due to the devastation had been simply piled into the middle of the road and was rotting in the sun and so you can imagine then the subsequent impact of that in terms of vermin in terms of disease and exposure to that those umbrellas that you see in the background use this fancy feature right here back here this is the food market that's going on and so you can see that that inability to put things to rest to reset them to get back to normal does not keep people from from attempting to do that but continues to impact their ability to do that another thing I saw in Haiti was some medical records that had been washed away and were piled up and there was actually a goat eating them at the time so that didn't didn't make us feel very good in terms of access to healthcare and records either this is just a photo of one of the infamous tent cities that occurred so again not even resources to be able to reside safely and securely and then this is water just access to water and you know we we hear about this currently in Puerto Rico about those basic needs that still months months after the hurricane still have not been put back into place and what what a devastating impact that must have for people who just thought okay as soon as this is over I can rebuild my life so let's talk about the phases of a disaster this slide came out of some research by Zunan and Myers and and subsequent research has really indicated that this is true for communities agencies and individuals when we went to Haiti it was true for Haiti so it really there's not a cultural difference here as well so let me walk you through this and I also want you to think about when you respond when you go to a disaster area at what point are you arriving because I know from working through the red press that and doing briefings from when people come back that at what time period or what phase that they're responding very much impacts that the experience that they have because we all want to go help and sometimes that's well received and and sometimes we're faced with something else so this is pre-disaster functioning okay so this is basically a graph of functioning so the community the person the agency is doing fairly well fairly normal this would be their normal state right and then we have a threat of disaster if that is possible sometimes it's not and then we have the actual impact and so now you have the the low point of functioning right then comes this what we call is the heroic phase and this is when people respond this is when the country responds when salvation army red cross there's fundraising there's groups coming to to assist people are helping rebuild homes or clean out devastation and there's some really heroic things I think this is a adequately named phase in that there are some really heroic things neighbors are rescuing neighbors and helping out and you really do see some of the best in people as they come together and in those day-to-day details that that typically take up our lives and stress us out are stripped away and we're refocused on things that we feel really matter now at some point there's a honeymoon right so it it tops out and then we have this decrease in functioning and you can see that this this actually falls below the level of functioning here so people are used to getting some help and and feeling supported and encouraged and they start to believe that things are going to be all right and it will quickly return to quote normal and then they discover that there's another disaster or groups have to get back to their regular lives or jobs and they leave the focus is taken off and those resources that came in leave and so people actually and communities feel this sense of disillusionment that really really is devastating so this is an emotional devastation here that occurs following a physical devastation if you are responding during this time you will likely be greeted as as saviors helpful very thankful all right respond during this time this is a time where people are really angry and sometimes they feel that that the world or the community or the the nation has has left them behind or that they just don't care anymore and people tend to to be more irritable and angry here and then there's this really long extended and this says one to three years down here at the bottom and it really does extend beyond that where there's really a working through of grief and people over a very long term then begin reconstructing their lives and their communities and developing what we call a new normal right and this is punctuated by times of anniversary reactions or trigger events so for example another hurricane is a potential threat or some flooding there's smaller flooding in another area and people have some real emotional reactions to that legitimately so how are we directly impacted well these are the people that typically are are immediately impacted right so this it makes sense that our family members our friends our co-workers people that are there with us are impacted but it's kind of like that six degrees of separation right because you can go further away and so your family members that don't live there may be very concerned also the exposure to the disaster is is very telling here so it gets back to that individual response so the closer that a person is to that event then that exacerbates the impact of that so if you are working in a community that you also live in that is impacted by a disaster and so this occurred to me in response we had some flooding in 2008 in Indiana and my community was affected and so I was working 14 to 16 hours a day I was meeting with friends and neighbors and people I love that had been impacted there's a whole nother emotional toll that is present when you are working in your own community some of the mediating factors things that might mitigate that psychological distress is that you may have some prior experience with a similar event maybe you it's been a while since the event has occurred those things are mediating factors someone may have some individual perceptions about that event that causes them to maybe not be so impacted as they may have been okay so everyone everyone has is impacted by a disaster to some degree some of those reactions will cause enough distress to interfere with adaptive coping recovery and these are the broad categories related to that now I want to take a moment to just talk about neuroscience which sounds complicated but it's basically we're impacted by it every day and the more we understand about the way our brains work without getting into really big detail the the easier it is for us to understand what's happening so what happens unconsciously and unwillingly is that when we are we are faced by a threat or perceived threat our attention is basically hijacked by that perceived threat and our bodies become prepared for fight flight or freeze right so we have a flood of endorphins and other cortisol and stress hormone preparing us for that reaction for whatever we need to do but what our brains do is it our brains narrow our attention to the perceived threat which makes sense in a evolutionary aspect it's much safer to to assume a threat is there and avoid it than to assume the threat is not there and then be fall victim to that right so our natural reaction without us even realizing it is we will we will begin focusing on things that we find stress potential threats or potential stresses and what that is doing is is also excluding our brain is automatically excluding information that may mitigate that that may be positive information it may be contradictory information so all that any that potential positive information gets filtered out and we oftentimes don't even take that in we lose our ability to problem solve and to be creative because our our brains have basically been hijacked to to keep us safe so i encourage you that when you are in an area where there is a disaster or even on a day-to-day basis be aware of the fact that what you hear on the news or on the radio or whatever it is that you're reading if we are convincing ourselves that we are always under threat that is always how that is always how we will respond and that causes an ongoing stress so let's talk a little bit about some of the some of the impact psychologically and behavior rolling so irritability and anger self-blame or blaming others isolating ourselves from other folks or withdrawing feeling stunned or overwhelmed or helpless unexplained mood swings so oftentimes people will feel like they have a surge of emotion that isn't necessarily rationally related to what it is that that is going on at the moment and that is a common reaction to to such a situation certainly sadness and grief problems concentrating problems following simple instructions or remembering things are really common and so we make take great care to be able to to be very clear in our communication relationship problems marital discord comes up quite frequently frequently excuse me people will have physical symptoms if they've had an illness or or they have some type of physical disorder it is common that that suddenly kind of reemerges or can get worse people will can sometimes experience nightmares fatigue inability to sleep or want to sleep all the time gastrointestinal problems headaches and tremors sometimes people will will feel that again you're being flooded with cortisol people will begin over time to engage sometimes in risk behaviors and that can include sexual behaviors risk taking drug and alcohol and sometimes around about four months sometimes we see an increase in suicide everyone has some reaction that does not mean that it is not outside the norm so we say that these are normal reactions to an abnormal situation or could be common reactions to an uncommon situation so part of what we do is help people understand that so psychological first aid is a way to help do that so psychological first aid is a approach to working with people who have been impacted by a disaster or a traumatic event and you may have heard in the past and still to some extent critical incident stress debriefing a lot of people were trained in that that was originally designed for first responders and continues to be favored in that in those communities and organizations what the research did find is that sometimes critical incident stress debriefing which is a very formal procedural approach to debriefing did not over the long term reduce the onset of post-traumatic stress disorder and in some ways actually created more more exposure to trauma kind of secondary exposure to individuals who may not have been firsthand witnesses to some events so psychological first aid was developed it is currently endorsed by the world health organization and is also used by the red cross and so it's again designed to reduce the initial distress caused by traumatic events and to foster short and long-term adaptive functioning one of the nice things about psychological first aid it is so adaptable so you can adapt it to age groups to developmental levels to different cultures you can use it in a group setting with families and communities so it is very flexible in that sense and it's also very flexible in the sense that you do not have to be highly trained to be able to do psychological first aid it does require some training and those links at the bottom of your screen are online trainings for free that you can do complete that training but psychological first aid was really designed for neighbors or church members for non-mental health folks to help each other and to help the people in the areas that they're responding to so it i mentioned this a minute ago but this is applicable to all these methods or groups and then here are some of the core actions related to that so and this this is basically it there are eight core actions related to psychological first aid and this is making contact and engaging and i'll tell you right now that this is the hardest one number one is very much the hardest one and i'll tell you a story so i did train when we had the floods in indiana that i referred to a little while ago i was responsible for melding basically collaborating between our mental health center and the red cross to respond and so i did put put together my mental health team we did have a family service area where people can go kind of one stop if you've heard of that where people are can go and get their licenses they can file their insurance claims they can do a variety of different things you know file with FEMA things like that and i asked my mental health folks to go down there and and do some psychological first aid and then i would be there later a little later in the in the morning so when i got down there they were down there and they had set up a table in the one stop and they had a big sign that said mental health and they were all behind the table and everybody else was out in sitting in chairs or waiting in lines and doing whatever it is that they were doing waiting to get assistance and so i asked them what my staff what are you doing back here and they said well no one's coming up to talk to us and i said well yes because who would want to come up when you're already feeling overwhelmed and stressed out to the table that says mental health where you are all hiding behind and so this this is a good example of why mental health folks sometimes don't make the best responders in terms of the psychological first aid we're used to a fairly formalized approach this is really about just going out and talking to people so i sent them out to ask people if they wanted water to sit next to somebody and just introduce themselves and have a conversation and suddenly they were having those conversations so it's really just about introducing yourself and asking somebody about hey what's going on helping provide safety and comfort so you know what we're talking about is people can't talk to you they can't process things if they don't feel safe in that moment do they need a drink of water do they need some food do do they need to go to the bathroom and if you could just stand in line for them then they could attend to that just some of that basic kinds of stuff and then down through the different steps so just assisting in stabilization helping identify who needs more assistance who just needs somebody to talk to for a minute helping gather appropriate and and accurate information so after disaster when people are very stressed they're very concerned they're they're afraid the sense of safety has been stripped away they want information and if there's no information we as human beings tend to make up information if they're called rumors and we're really good at it and they rarely are very positive so providing accurate information or searching that out is very helpful offering practical assistance reconnecting people to their social supports helping them remember how they've dealt with stressful situations in the past and linking them with anything else that they need those are basically the core actions of psychological first aid so what does that mean for you it means that you're going to listen to someone that that you are going to be with someone we're in a society we live in a society where people feel like if we're not doing something if we don't have something to show for what we did then it's not real and what we forget is that one of the most powerful things that we can do is take time give someone our attention and to just really listen to what they have to say and it's not about what we want to hear it's about what it is what is the story that they want to tell and it's being respectful about that and listening and we know that from the research that allowing people to tell their story in their own time in their own way allows them to take those emotions and those thoughts that feel very disconnected in their body and in their experience and start to find a place for those that make sense to them and and lots of times we won't see that or know that kids do this inherently they're very natural at it if a child experiences an event that stresses them out or that scares them what you often hear is over and over and over again that same story over and over and actually parents and adults tend to get very frustrated with this like drop it already are you know just move on to a different topic but they naturally know that this is the way of processing they play they'll tell the story we I had kids in the waiting room after 9-11 that were building the towers and airplanes out of Legos and repeatedly crashing them and the the adults in the building were very upset with us until we reminded them that this is how this is how kids tell their story they do it through play this is not therapy this is simply being there with someone and being there also means that we're sensitive to different aspects of diversity so in Haiti we were able to use psychological first aid because we were listening we weren't telling we were providing some information but we were letting people tell their story and so because psychological first aid is so adaptable it really does not there's nothing about it that you're imposing your own beliefs your own culture your own religion onto someone else so what do survivors and responders need first is to feel safe and secure without that we're I mean we're just not going to move forward to be able to have their basic needs met and then to be able to tell their story because that that is their way of making sense and again this is trauma is a process and so is reacting and healing from trauma it's a process it is not an event to reconnect with coping skills because again that's the first thing that we forget in a crisis is how we've been successful in the past because we feel so overwhelmed in that moment so asking people questions about ways that they've dealt with things in the past or things that they've overcome can sometimes help them regain that that sense of purpose and strength or to remember yeah you know you're right I I have handled some really incredible things in my life and I can get through this as well so the guiding principles of psychological first aid so we're creating an environment remember we're not we're not doing so much as being so we're being calm we're helping people stay safe or feel safe we're connecting and human beings are we are social we are built socially we learn socially we experience socially um self-efficacy which is basically that sense of that I can and will do it and that is is built on past successes and reminders of those past successes successes we're empowering and helping people have hope and you know I very early on one of my professors said if you do nothing else when you meet someone for the first time for a session it at least at the very least give help them have a sense of hope because if we do not have hope there is no purpose in moving forward you don't believe that it's going to get better I mentioned earlier that some of the things that some of the reactions that people have include some cognitive distortion right so really having memory impacted and people people get really concerned about this it's like you can have a common and people and and responders get very frustrated with this so you may be working with someone who has been there for for some time or maybe been directly impacted and you have given you know you've had a conversation you really do something or you have a you have a set of steps that need to be done in order it would be very common for someone to that it's been impacted by a disaster to have to not be able to remember that or to not be able to follow multi-step instructions to not remember acronyms okay so we use as clear language as possible we are very direct short short simple sentences short instructions patients a lot of patients I sat there with an individual and this was a therapist down in Gulfport and she she was a therapist in the community she was directly impacted and she was drinking you know at that point in time Walmart had back had opened liquor stores had reopened and she she was drinking about a bottle of wine a night and and so I in my my own mind of course did this brilliant intervention and talked to her about that and you know reminded her about what she worked with with other people you know but prior to the disaster about alcohol abuse and things like that and so I thought we had this great conversation and then at the end of it she said now tell me again why I shouldn't drink I mean so it was like that that whole conversation didn't happen I thought that we were having this great moment and I was being really effective in reality I missed being with her okay I missed I was telling I was doing I wasn't listening um as human beings we frequently um don't want to engage because we don't know what to say uh and then when we do engage and we feel uncomfortable we have a tendency to say some things that aren't that great and so this is just kind of a list of of things that people commonly say that uh that we suggest that you don't because it it's for the person on the receiving end it can feel like a platitude um like you're not really validating how they feel so it's really more about just listening and uh you know it's perfectly okay to say like I I just don't know what that would be like or I I can't imagine what that was like for you um it's uh for telling telling someone that um it will all be okay um or I know exactly how you feel well we don't and we don't know it's going to be all okay I don't know how that person feels because I'm not done so this is just a little note in here to be be careful of what we say um so let's talk about a little bit about self-care for responders because um as I noted earlier um as responders you are also survivors and subject to all of those same um reactions that that we describe before for someone who is actually um has was actually direct directly impacted so in addition um responders have some some uh other things that we do to ourselves which is that we have a little sometimes have a little sense of grandiosity and it is really difficult um to not help or to feel like it's okay to leave because it's not done or to take that moment for self-care because there's so much that needs to be done and the bottom line is that if you choose to respond please um have value done a self-evaluation are you in a position that you feel like you emotionally physically financially can do this because okay here's a good example so here is some I responded to 9-11 and I'm showing up to check in and here's a woman who just had a hip replacement and she is there to respond she cannot carry her own baggage or luggage she cannot she's very limited in our activities we have spontaneous responders right that show up this happened in in Hurricane Katrina people showed up and said uh oh hey so can we join your camp or do you have a place I can stay or do you guys have supplies be aware of where you are emotionally physically financially like I said because um if you are unaware and you go you may very well become a drain on those resources as opposed to an assistance and I don't think anybody intends for that to happen so have a plan have have identified resources um have these discussions and this awareness beforehand know what is going on don't please don't avoid uh meetings or uh information that is going to be valuable to you be open to the fact that other people may notice that you're not um firing on all cylinders for lack of a better term right you might be stressed out you may be experiencing some of those reactions um be open to the to the idea that someone may be able to give you feedback about that because as a responder in the middle of it that and experiencing it I'm not the best person to be objectively identifying what's going on with me all right I'm in the middle of it I need to be able to eat drink get my exercise I need to maintain my connections I need to be social but I also need to take time for myself and that you know that the amounts of that vary per person um if when I am looking for team members um I will always say that the first thing I'm looking for is flexibility because it will never go the way you expect it is very very likely to that you want to get there and you want to help and you get there and you end up sitting on your hands for an extended period of time because that's what happens in disasters the information is coming in the decisions need to be made and the deployments need to be decided upon and and sometimes we just have to wait for that and to be frustrated or angry um is is not helpful and actually is exacerbating that situation when you come back again uh this is a time to uh to take care of yourself you want to participate in the debriefing because that is also helping you to um be aware of what's going on um to put those things those feelings those emotions into a place that makes sense for you to recognize that while you were gone other people's lives went on and they have feelings about that too um it's we like to say uh to to responders give someone permission to give you feedback when you come back on on how they they see you functioning how they see you doing do not make it a spouse or a partner because then there's other dynamics that uh that get involved in that and make the agreement that they can come and tell you to give you feedback or express concern you don't have to agree with it you just have to consider it all right and you'll be amazed that you may be acting or being in a manner different than than you think you are but that honesty and that openness can help you get back to where you want to be these are common stress reactions in responders again you'll notice that these are uh some of the same reactions that occur in people that were directly impacted so just to summarize because we are at time basically psychological first aid and again the links there are at the bottom of the screen to do some online training it doesn't take a very long time and actually it's very good training you can there's been yet and it's very interactive i've done it i i've actually enjoyed it so i highly encourage you to do that this is a method to help people deal with the results of disasters and traumatic events it's also a method of helping responders deal with the the effects and aftermath of aftermath of responding to those events so i hope this was helpful to you and i highly encourage you to great well thank you so much jody go online and explore that if you haven't already the presentation was really helpful information and um before we jump over to the questions there's been a few that have come in so far i realized i neglected at the beginning of the presentation to ask a poll question that we wanted to field with this group and i know that many of you were involved with response to hurricane harvey but just to kind of some conversation going if you all could just quickly answer this question if you've ever been involved with responding to a large-scale disaster so whether it be harvey or any other storms prior to that or any other regions that you lived in where you had responded just help put a get a sense of who had somebody's first hand and for those of you who did i encourage you to draw on those experiences and thinking about your own psychological state and if you have any questions relating to this program that you can share with the group okay so jody i'm sure you're seeing this too it's about 50 50 which is really incredible yeah so um well let's go ahead and uh turn over to the questions so the first one we have is from jennifer who was wondering how we as responders can help inspire hopefulness shouldn't say that things were better how do you walk that jody uh that's a great question jennifer thanks for that so um i want to make sure i answer this appropriately so um the difference is really um in what we're saying or how we're saying it so when we just say oh you know what it'll all get better um that statement in and of itself is really not all that helpful because people aren't feeling um like all of a sudden it's going to get better there and when we say that and it oftentimes doesn't resonate with what their current experiences so they kind of cast it aside like you don't understand me you don't understand what's going on and so then we've lost that connection with them on the other hand i mean i really like that question because we do want to inspire helpfulness or hopefulness so um helping people understand that um what they're going what they're finding is a new normal okay it is it it is not what they experience up to this point that things are different that that validating of how people are feeling um is is really important because that that's what that's what really impacts that kind of helping people remember um things in the past that they've successfully overcome um helping them understand that what they're experiencing is not a bad thing it doesn't mean there's something wrong with them it doesn't mean it's that's something they're going crazy because that's what people oftentimes think is like if i'm experiences like i can't remember things i can't i can't follow simple directions there's something really wrong with me and if they don't talk about it then they get more anxious about it and then that that makes it worse so that sense of hopefulness can really come from um normalizing those responses to helping them answer yeah Jennifer just tried to say thank you for that response to it things are going to be different um then we had another question from Mary beth who's wondering about uh reconnect where early on in your remarks you talked about the importance of keeping cash and she's wondering where you where you keep that if anything could potentially be destroyed your your car your house your office right so um that's a really good question too so uh there's there's two different answers to that so one is i encourage everyone i know all my friends and colleagues to carry um 40 in this class and i can't tell you how many people have just said you know i left the house i didn't have my wallet i ran out of gas and i'm so glad i had that 40 dollars so just on a day-to-day basis i just really encourage people to do that um what i typically do is i i have a fire proof safe and i um there's some money in that it's now you can't you know i i can't guarantee right that that that that i'll be able to recover it people do a variety of different things if you have time to prepare for a disaster you know what's coming you can uh always keep that on you in in some way and melissa had time to have that resource maybe you can get one of those travel money belts to wear underneath your clothes so i think that might be some of that cash helpful idea it doesn't have to be a lot of notice but just so that you know you have things like your your cash your ids on hand and it's harder to lose than anything else um so oh and mary beth just chimed in saying she just had a small safe at home with burst of duplicates so good thought um great so then there was also just a question um about whether or not we could have the powerpoint slides from mary beth as well so i'll just tell you mary beth we will make the recording available for anyone who is interested in seeing the presentation again um and we'll also be sharing the links on a web page too so that you can always access the recording in the links great did anyone have any other questions related to the content i will say that you know this is very helpful information for you all because um although you may be responding to an event outside of your your home area um you know for example could be based in austin and go help in houston or vice versa across the state it is really important to think about what might happen if the event is in your own home area and how dealing with the disaster on a personal level affect your ability to respond so just thinking about looking in on yourself and checking in on your fellow responders too and just keeping in mind some of the signs that jody has let you all know about i think key for working effectively as a team and also i just want to emphasize to um and jody mentioned towards the end of her remarks about and selecting teams flexibility is key and that's what we've really found in working with the national heritage responders team and anyone else who's been involved with working in this field just recognizing that in yourself it's not going to be an ideal situation so you have to be able to be the most flexible version of yourself in order to to effectively work in these kinds of environments so thank you for bringing that point up jody okay well i'm not seeing any other new questions coming in um so i'm just going to go ahead and move this back over again the schedule of all of the upcoming presentations a reminder that this will be available on the website that i shared with you all previously um that has all of the information about the self-study portion of your training which i can share in the chat window again momentarily but uh our next program is going to be on march 7th we had that um up in the air when i first emailed about the series so it has been scheduled for the 7th so just in a few short weeks um on a broader topic of health and safety issues in a disaster situation so um keep an eye out for the invitation for that program and then i also wanted to share with you all the risk of blocking the upcoming schedule um let's see if we can put it up here just a quick link to a survey for this webinar it's very helpful for us to have information about um your feedback on this program so it should take less than five minutes if you're able to just um again use this box as the web links box below so just click on the the text in blue and click on browse to and that should take you to the survey so jody is there any other closing remarks that you wanted to make before we wrap up the session uh just to thank you i really i really enjoy talking about this topic and um and i love that people are so interested uh in responding and understanding the psychological dynamics of that um and just a just the last reminder that um you know to take care of yourself that self-care is really uh really important here because if you're going to be an asset to your team and um able to really assist uh as well as come back well thank you so much jody so free culture through the challenges of getting back