 All right. Thank you all so much for joining us for today's webinar. This is of course the second in your eight-part series to complement your in-person training for the Seattle Heritage Response Team. These programs are made possible through the generous grant funding support of the National Endowment for the Humanities. It's been a little while since the first webinar in your series about disaster fundraising. Today we're discussing the very important topic of psychological considerations in disaster response, both for those who are affected by the disaster and for the responders. Next week we'll explore a related topic, health and safety. We'll look at what hazards you'll face as well as what personal protective equipment you'll need. Beginning on August 22nd, we'll move into programs that address material specific salvage considerations. And actually the presenter of that program on August 22nd is joining us here today, David Goist, who will be speaking about painting salvage. We'll move on then to textiles, photos and electronic media, book and paper, and then wooden and upholstered furniture. We'll wrap the final program on October 10th, which will be about three weeks before our final in-person meeting and disaster scenario training. If you miss any of these webinar sessions, I'll email you with a recording of the program after. Write to me when you've finished and I'll note your attendance. It'll be expected to complete all webinars before we meet again on November 1st. Before we begin today's presentation, I just wanted to share some brief technical notes. On your screen you'll see several boxes including one labeled chat on the left-hand side. I think most of you have found that. You can use that chat box to say hello and ask questions and share any information or links that you'd like. 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 her 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 the page. And with that, I'm very pleased to introduce you all to our presenter, Dr. Jody Horstman. Dr. Horstman is a PhD, HSPP, and a licensed psychologist. She has 28 years of experience and community mental health, serving youth, 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 Community Services. Since 2005, Dr. Horstman 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 9-11 as a part of the Indiana Task Force that assisted Mississippi following Hurricane Katrina and worked in Haiti following 2010 earthquake. She is a member of Indiana's State Disaster Mental Health Team and a trainer of Psychological First Aid, also known as PFA. Dr. Horstman received a Bachelor of Arts degree in Behavioral Science from California State Polytechnical University and her Master of Arts in Doctoral Degrees in Clinical Psychology from the United States International University in San Diego, California. And with that, I'd like to turn things over to Dr. Jody Horstman. Okay, I think that I'm on now, so thank you very, very much for your patience. I can already tell that you guys are going to be great responders because the first thing I look for in a responder, of course, is the ability to adapt to the situation and to be flexible and adaptive. So, appreciate, really appreciate your patience so far as we work through those bugs. So, thank you and thank you, Jessica, for your introduction. I appreciate that. It's always odd to listen to someone talk about you, but I also want to point out you never know, really, when some of these skills are going to come into play or when you may be called upon to utilize them. So, I reside in Indianapolis. However, I work in Noblesville, Indiana and some of you may have heard of Noblesville recently because we had a school shooting and I was able to train some of my staff that had not been trained in psychological first aid and we were able to quickly get up to speed in terms of responding to that school shooting. So, psychological first aid, which we're going to talk about a little bit later, is very adaptive and very flexible to all sorts of situations. And so, I'm really glad that you all have taken the opportunity to be able to learn a little bit more about that. Okay. So, I believe I am driving now. Yes. So, this is our agenda and we still have plenty of time. So, there's really this, our technical difficulties have not cut into the presentation time. We're going to just talk a little bit about disaster overview, just to kind of give you some context and some definitions, then move into the psychological consequences of disasters. Talk just a bit about some special population considerations, the needs of survivors and responders, and then some of the guiding principles of psychological first aid. And then, what I'd like to think of really is one of the most important parts in that self-care and recognizing when you need to take care of yourself, how you need to take care of yourself because just like you watch on an airplane, you know, when the mask drops, it's important to put your own mask on first so that you are then able to assist others. So, that kind of gives you an idea what we're going to talk about. So, the first thing I'm going to talk about is resilience. And the reason that I talk about that first is because we often underestimate it. We hear a lot about trauma and about people's response and traumatic reactions or post-traumatic stress disorder. What we don't necessarily hear so much about is resilience. And resilience is really the ability to bounce back and to move forward. It reflects an ability to maintain a stable equilibrium in the face of obstacles, difficulties, problems, crises. What we don't appreciate often is that resilience is very common. And mental health workers, like myself, typically underestimate that. That's not what we're trained to recognize. We're trained to look for problems. And sometimes when people don't present with difficulties following a crisis or a disaster, we misinterpret that. And that's the same reason that psychological first aid and disaster response does not always call for a licensed or a trained mental health responder. And psychological first aid is really designed for your neighbor, for your fellow church member, for family members. And so this is certainly applicable to you. We hear a lot about post-traumatic stress disorder. About 85% of American adults will have been exposed to a potentially traumatic event. And we're going to talk a little bit about what that means. But really, only about 8% ever develop any post-traumatic stress disorder symptoms. That doesn't even mean a full diagnostic meeting of the criteria. But you think about that. So the majority of us as adults will have, and you think back into your life, right, you have been exposed most likely to a traumatic or potentially traumatic event. But that does not mean that you have developed symptoms related to that. Okay, so let's talk a little bit about what happens in a critical event. And then we're going to talk a little bit about some other definitions. So when there is a critical event, and that's usually reflective of that there is some significant loss, right? The thing what we often don't anticipate or don't appreciate unless you have some experience in looking at or being involved in a broad disaster is really the extent of the loss that occurs. So this list is really meant to bring to mind, top of mind, all the different things that we're talking about here. So potentially you may have lost loved ones, or people that you care about, or people that you know. Certainly we often see that people have lost material goods. What we often don't appreciate or understand is that employment, people's financial stability, is often impacted here. Their ability to feel safe. The social cohesion of a community or an organization can often be impacted, our own self-image. So I'm going to show you some pictures. And these here are from Katrina. So when we arrived at Katrina, these are some of the scenes that we saw. And when you think about our support systems and the things that we typically turn to, people, places, social supports, that when things go poorly in our life, where do we look? And oftentimes that is our spirituality or a religious institution, or relationships that we have there and appreciating that those may not be there after a disaster situation. You also think about, if you had a fire in your house, or your basement flooded, or something like that, the first thing you might think of is, well, I'm going to need to go and stay in a hotel room, or I'm going to go and stay with a friend or a relative. So in a broad scale disaster, those options may not be available to you. This was one of the hotels, or a motel that was close to where we were camped, which was actually on the parking lot of what used to be the convention center. So that kind of, that your ability to access those types of supports may not be there. We may not be able to get somewhere. One of the things we don't anticipate sometimes is, just because we take it for granted, is I can get from one place to another, or I can go and I can pick up my medication, or I can go to the grocery store. This would have been the grocery store. So the ability to go and pick up some of those essentials, or have access to some of the things that you might normally want may not be there. So what exactly is a crisis? A crisis is really something that occurs, that exceeds the resources that we have available in the moment. And so that, that's part of what makes this very unique per individual, and where we often misunderstand and get frustrated with each other. So let me give you an example. If I have, if I'm on my way to work and I have one vehicle, and I get a flat tire on the way to work, if I have the insurance or AAA, or I have the money to get that fixed, or that repaired, or have someone come do that, that may not be a crisis for me. If, however, I don't have that resource, I don't have those funds, I don't have the ability to reach out and get that assistance, that may very well be a crisis for me. So it's really individualized. Whenever we are faced with the situation, I mean we're carrying some stress. We're carrying some things that are on our mind. Some of us may be dealing with financial situations, or we may be dealing with relationship issues, or maybe we've lost our job. Those are events, those are problems that we are carrying with us that are, that are utilizing our resources. So depending on how you're carrying that with you, or the people that you're talking to have been carrying that, one more event that may not seem like a big deal to you from externally, may be kind of the straw that broke the camel's back. It just exceeded the resource, and so that person is having and experiencing a legitimate crisis. Trauma, on the other hand, is not a particular event. Trauma is our perception and experience of the event. Trauma actually is not so much a rational, logical experience, as much as an emotional and biological experience. So think of it as an event occurs to such extent that in our minds that the actual event itself and the emotional experience of that are almost not connected. So we are stunned, like a bolt out of the blue. It leaves us feeling overwhelmed, we're disconnected. Oftentimes our emotional, and we'll talk about some of the other reactions, don't logically fall in line with what actually happened or our memory of the event. And so trauma typically is related to things like events that may have, I'm sorry, may have put us at risk of significant loss, physical injury, or death, if either ourselves or someone that we care about. Reactions to trauma are a process. They are not an event. So when someone has had a traumatic situation or experience, simply talking to them one time or kind of having them talk it out is just not going to be enough. Our coping with trauma is going to take a period of time over which those experiences and our memories kind of reintegrate. So what are some of the psychological consequences of disasters? First, let's talk about the psychological footprint. So psychological footprint refers to the impact of that disaster or that event from a psychological versus a medical footprint or medical aspect. So when you see a widespread disaster, say the flooding this year, this past year, that parts of the United States experienced, right? So what you will often hear about in the news is the financial kind of like the cost. This is what this disaster is estimated to have cost or this is how many people have been injured or have been killed. What we don't hear about is the psychological footprint. And this picture on here is really to represent how those two things compare. The medical footprint tends to be much, much smaller than the psychological footprint. So we talk about hospital surge, for example. So let's say that there is an event where maybe something happened at a school and parents don't know where their children are. So we may have had one injury or in particular in this last incident that I referred to, we had two injuries. Yet we had thousands of people show up, right? Because they didn't know what was going on. And so that also happens when there's a disaster and there's medical issues. So there may be very few people that are injured, but where do you go when you don't know what has happened to your loved one? You typically go to the hospital if there's not communication. So hospitals are often inundated with what we call surge, which are people that are showing up wanting information, which overwhelms the medical staff. But these are equally as valid, these reactions. We have people that show up feeling ill related to anxiety or fear, right? Just fear that maybe they've been exposed. So one example of this is the anthrax. So back in 2001, if you think about after 9-11, how many folks developed some kind of anxiety related to potentially being exposed to anthrax? So there were actually 22 direct casualties, yet our entire mail system, our medical system, our hospital system were inundated and they're functioning impaired by people's psychological responses to this issue. And this is one of the things that illustrates the importance of being able to do some type of psychological response to folks that don't require medical professionals, right? To be able to have those conversations, to be able to intervene and know how to do that comfortably so that people can begin to resolve these without necessarily seeking formal interventions or impacting the functioning of other resources. These are some pictures of Haiti after the earthquake. So one of the things in a widespread disaster is that the entire infrastructure needs to be rebuilt. So Ekaterina and in Haiti are both good examples where the infrastructure, the government, the community, the agencies that we anticipate being there to support us, to guide us, to provide that response frequently are not available. So we know now that the recommendation is that if there is a disaster that each of us as individuals should be able to and be prepared to basically care for ourselves for a minimum of 72 hours, so ourselves and our families. So we should have our own disaster kits. We should have our own resources, our own plans of communication in order to do that because it may very well take 72 hours or more for an emergency response to be brought to bear and for that assistance to occur. Basic services are impacted. So this is a pile of trash basically because there was no trash cleanup. There was no, there was rubble. There people are living day to day and this is basically piled up in the middle of the street. And if you look at the umbrellas behind that, that is the food, those are the food stands. People are selling food right there. So you can think about, you can see how the disruption of the infrastructure then can bring about even more disaster or more crises as disease may be spread or infection. Basic housing. So this is a tent city. I think most people have seen something like this on the news or in pictures. And so this was widespread. People had nowhere to go. And if they did have somewhere to go, those buildings weren't necessarily safe. And then just basically attending to your basic needs. So this was clean water. And you can see that people had lined up their containers to be able to access that clean water. So things that we typically take for granted are things that it doesn't really necessarily enter our awareness that a widespread disaster could take those things away from us. So what are the phases of disaster? So this is a chart that was developed to really kind of illustrate the phases that people, communities, agencies in geographic areas experience when a disaster occurs. And it's surprisingly consistent across all of those different aspects. So it could be this a person could experience this, your agency could experience this, your community could experience this. So the line represents basically functioning. So pre-disaster we have a fairly straightforward level of functioning. There's some warning that starts to functioning starts to drop. There's the actual impact. So that would be the that first dip. And then what's called the heroic phase. So the heroic phase is when friends, neighbors, emergency responders, the community comes together and they are helping each other. And in widespread disasters, this is where the Red Cross, the Salvation Army, the Religious Organizations are mounting teams to respond. That there's money coming in from FEMA. There's shelter setup. There are family assistance centers set up. There's all sorts of disaster response that's occurring. And you can see that this functioning level climbs here. I mean, a community that's at the heart of such support, yes, that feels good. People are doing some amazing things. And then you see that it tops out at some point, which is what happens because eventually folks, another disaster occurs or they've responded and now they need to get back to their home or to their job. And that cannot continue for a period of time. However, so we call this the honeymoon. So we have a really kind of cohesive experience. And then people leave. And that is hard and often unanticipated by the people, by the communities and people that are impacted by the disasters. So then you see this functioning level drop. And you see the word disillusionment because people get really truly disillusioned by this. They have felt like there was going to be all this help. And it is very, very common for people in communities to believe that, okay, everything's just going to go back to normal. But that is absolutely not what's going to happen. What's going to happen is that they're going to establish a new normal. But that's a hard process. So people often feel abandoned. People feel angry, irritable. Responders are often at this point kind of targets of anger because people need someone safe to be able to kind of vent that to. And then there's this long period and it's extended. And it can go beyond three years. It can go for years and years in terms of reconstruction where the community has to establish that new normal. They have to weather those anniversary reactions or trigger events as they come up. And you can see that it's a long, difficult process. And we see, you know, Haiti, Katrina, that those communities still have not recovered. So who's potentially impacted? Well, it's not just the people that were necessarily geographically there. It is their family members. It could be their friends who are maybe live across the country that are concerned about them. It could be their co-workers. It is definitely the emergency responders. And it could be anyone who is a witness to that. So I'd like you to remember back to 9-11 when we all saw those videos of the planes hitting the tower. And they played that again and again for an extended period of time, right? And you think about directly how many individuals were impacted by that. Either they were physically present or they were there as a witness to that. And then what the ripple effect of that was across our country. So oftentimes the potential psychological impact or footprint can extend well beyond the geographic area that it occurred. So what? Yeah, I think we just lost. So a disaster is a sudden calamitous event that seriously disrupts the functioning of a community or a society and causes human material and economic or environmental losses that exceed the community or society's ability to cope using its own. Okay, Jodi, do you want to just try testing again? I hope you can still hear me okay, but you cut out at the beginning of that last slide. So I'm still not hearing anything from Jodi. Let me try typing to see if something comes through. I'm not sure if there was a disconnect. You might just need to have her log out and log back in again. Yeah, Jodi, it looks it seems like your microphone says it's picking up but there's still nothing. So if you don't mind logging out as soon as you log back in, I will dump you up to present her again. Thank you. Thanks everyone for your patience. Okay, let's try this again. Jodi's back in and I think we lost you here on this slide, Jodi. Okay, well let me make sure that you can hear me. We can. You sound good. Thank you. Okay, great. All right, so what I was saying on this slide was that a disaster is like a crisis for a person. A disaster is that for a community. So it's a sudden calamitous event that seriously disrupts the functioning of the community that exceeds the communities or society's ability to cope using its own resources. So that's one way to think of a disaster versus a crisis. So let's talk a little bit about what are some of the impacts of a disaster. So we know that there's basically five areas in which someone will experience some type of reaction and everybody experiences something but not everyone will experience everything and not necessarily experience something to the degree that it's going to interfere with their day to day functioning. So there is a very individualized response to this. It's going to the psychological distress is going to be related to a few different variables. One is your closest closeness to the event and the intensity of the exposure. So some of the things that can be of assistance in coping with a disaster is that you may have had prior experience with some type of event similar and have gotten through that and have built some coping skills related to that. You may it may be that the resources that are available for that particular individual like we talked about before some people their resources are really tied up already with issues or difficulties in their life and is this just you know that tipping point. If you are working as a responder in an area that is your own neighborhood for example or it's the disaster has impacted people that you know we know that that increases your reaction to the event. So let's talk for a second about what our brains do when there's a disaster. So our brains are complex and our brains have developed a very complex and involuntary method of keeping us safe. So our attention is the way our brains are biologically designed is that our brains look for a portion of our brain. The amygdala is looking for threats. It's always constantly scanning for threats and when our attention is directed to something that we perceive as a potential threat then our brain is almost hijacked by that and there's a whole range of different things that occur. Our bodies prepare for fight flight or freeze right. Our attention narrows to that threat which often means that we are not able then to take in or even aware of positive events or things that may contradict what we perceive as a threat. Positive information can be filtered out and we lose the ability to creatively problem solve or even sometimes logically work through something. So now this is not unique to a disaster okay. This is about how our brains respond in terms of threats. So you can also apply the same premise to you know if you're watching a news channel every night that's telling you how terrible something is your brain is experiencing that is real and all those things are still happening. In a disaster of course this is that on steroids. So some of the things that occur in terms of physical and behavioral reactions are that we may experience things like loss of appetite headaches or chest pain, GI problems, sometimes hyperactivity or just feeling like jittery like you got to be moving. There is a tendency for people who have experienced a disaster to especially if they previously have used this as a coping mechanism to increase drug or alcohol consumption. We know that these are common reactions so there is there is nothing in and of themselves wrong or abnormal about these reactions okay. These are normal reactions to an abnormal situation. It's part of how we're designed. We may experience nightmares, insomnia, fatigue, oftentimes people who have a pre-existing physical condition whether it's GI or arthritis or something like that experience a re-emergence of this. Sometimes people engage in some high-risk sexual behavior. People may also tend to become very irritable or angry. They can be blaming toward others or blaming toward themselves. Some people tend to want to withdraw, others tend to want to not be by themselves. Oftentimes very, very common reaction is that people are afraid that this is going to occur again or they become hypervigilant right to that something else is going to happen which makes perfect sense because we live our lives in a state of denial to some extent. We basically wouldn't be able to leave our house if we thought of all the terrible things that could possibly happen to us so we kind of screen those out. We don't think about those but when a disaster occurs that sense of safety and denial is just very harshly ripped away and so all those potential bad things that could happen are now top of mind and so that feeling of safety that we live with on a daily basis is gone and people of course are very anxious about that. One of the things that can occur sometimes is that people feel what we call a cascade of emotions so not necessarily in any logical order not necessarily connected to a particular event. It could be that all of a sudden they feel like crying or all of a sudden that they're angry or all of a sudden they feel a lot of different things and nothing has necessarily occurred to trigger that. It's just kind of this cascade that comes over very common. Concentration and memory problems. I just talked to you a little bit about how the brain works so it makes a lot of sense. Our attention's been hijacked, we're very hypervigilant, we're very aware and being able to follow a conversation or multi-step task it sometimes becomes very difficult. Relationship problems can become an issue so we see long-term some issues in terms of divorce and things like that. Oftentimes there's some spiritual issues as well as people question. Some people that faith is very important to them are driven deeper and they become more connected to their spirituality or their faith. Others start to question like how could this happen? So these are all common things that you may see in folks that you talk to or you may experience yourself because as a responder in a disaster situation you also have become a survivor of that disaster. Sometimes we fail to appreciate that but you are also experiencing some of those things first hand but also second hand vicariously through the stories that are the people that you're interacting with. So anything that I just listed here that other people may experience a responder may also experience. So let's talk a little bit about psychological first aid then. So psychological first aid is endorsed by the World Health Organization as a way to reduce initial distress caused by traumatic events and to foster adaptive functioning. It's one of the nice things about psychological first aid is that it's very nimble. It's very adaptable. So you can use it in all sorts of situations with all sorts of types of folks. So I've done this in Haiti in a tent city. I've done it formally in a school. I've done it in groups. I've done it in people's yards where neighbors have gathered and I've talked to people about that just spontaneously. So it basically talks about that in that slide. So there's some core actions here and we're not going to go really deep and broad into psychological first aid because those links that Jessica had mentioned earlier that are at the bottom of your screen. Those are two links where you can go online and actually get the training. It's an interactive training on how to do psychological first aid and it has some great vignettes and things like that. So if this is something that you're interested in I would highly encourage that. And you never like I said you never know when you might be called upon to utilize that whether it's with your neighbor or someone else that you know. So the core the core actions for psychological first aid are basically and are these eight and I'm okay are we still here? So I had another link pop up there. The first one of these is by far the hardest. So this is making contact and engaging survivors. Socially this is this feels very awkward for folks and it's really just about reaching out to folks and having just a natural conversation. Hey I've noticed you sitting here. How's it going? Oh you know what has what has your experience been? Can I basic things? Can I get you some water? How's your day been? What's on your mind today? Just simple kinds of conversations. It does not have to be this formal approach to having some kind of intervention with someone. So I by far for my mental health providers this is the most awkward thing for them to do because they're used to having a more formal setting. The second thing is really providing safety and comfort for someone because they're not going to be able to move forward in having a conversation if they feel unsafe or incredibly uncomfortable in this particular situation. So like I said holding just holding someone's place in line while they go to the bathroom or getting someone some water any of those basic kinds of things. Assisting and stabilization is really about just helping people recognize that this is this is probably a long-term process. What are their immediate needs? For example we had an individual who was who came to a family assistance center and my responder came back to me and said I have I don't know what to do this person lost their home it's been flooded and they they have insurance they have money they have access to the bank they have a car but they're sitting here and they don't they and they're not sure why. Well that goes back to what I was talking about before that we're not necessarily thinking very clearly when we're overwhelmed so it was really about kind of just hey so let's talk about what it is that you might need and what your next steps might be and that's all that that person needed was really to have someone sit with them and talk and let let him bounce that off. Oh yeah I could yes I could get a hotel oh yes my insurance will cover that and just given him a sense of direction so it was just kind of stabilizing where he was gathering some information about his current needs and then offering some practical assistance so you know do you know do you know where to go to get a hotel room what are what what are some of some rooms that are available in this particular area things like that oftentimes information just about what's going on because the first thing that goes out the window in a disaster is accurate information and as human beings we have a tendency to if we don't have information we'll make it up and then we'll spread it as if it's true and I don't know why we do that as a human being but that's what we do we tend to fill in the gaps I guess it makes it makes it us feel better but at the same time often spreads misinformation so just giving people some accurate information about what's going on and if someone says I you know I need to know about this and you don't know being honest about it and just saying well I don't know that but let me see if I can go ask reconnecting with social supports so earlier we talked about crisis and the first thing that goes out of the window when you experience a crisis is your memory of all the things that that you've brought to bear in the past to be successful with problems and obstacles so because at this moment we're feeling overwhelmed like our resources are inadequate to meet our needs and we forget we forget we've dealt with all sorts of things in our life and been successful at it things that at the time felt overwhelming then too so helping people reconnect to their social supports to their own coping skills reminding them of times or asking them about times that they've been successful in the past and how they've handled things can be really really valuable information on distress rate actions and coping those are some of the things I just talked to you about psychological physical cognitive spiritual so that people it normalizes that for folks so that they don't have to feel like there's something wrong with them we have a tendency to to have these reactions like I said earlier some people will experience some everybody's going to be impacted in some way but if we think that there's something wrong with us by feeling this or experiencing this and then we don't say anything and then we become more anxious because we think there's something wrong with us then it just builds and it becomes exponential so basically having some information about hey guess what this is a really common reaction that see that people experience can really go a long way in helping people kind of regroup and then linking them with any of the services or needs that or agencies that could meet their needs in the area is is the last core action so you can see that none of none of those actions require a degree or formal training there are all things that any of us can do for our neighbor or someone that we that we just care for so psychological first aid really talks about it's really about respectful listening so there's models out there like critical incident stress debriefing where there's a series of steps and things have to go in a certain order and people there's rules about participating but psychological first aid is a great model because it's really about letting people tell their story and it's in any order that they want starting wherever they want and what it does and what the research has shown is that as people get to tell their story that disconnect between that those those really overwhelming emotions and the things that happen start to reconnect in our brains they start to link back together in a way that that our brains can make sense of and that's the part that really starts to decrease our reactivity or are some of the things that we may be experiencing so it's really about letting people tell their story kids do this naturally when something kind of scary happens to them they will tell you again and again and again until you're tired of hearing about it but it's actually very adaptive they are doing exactly what they should be doing and it helps them just in the same way that psychological first aid does it's also very sensitive to culture so when we when we are responding anywhere these are the things that we want to be be sensitive to is there a particular culture a sub a subculture in in Katrina there was a I didn't I didn't realize a lot of people didn't realize that there are a lot of Vietnamese fishermen fishermen fisher people with boats doing a lot of shrimp uh shrimping I guess is the term and um so there was a whole culture a whole different language that was used there that I was unaware of at the time and so you know some adaptation had to occur to help engage those folks um sometimes religious diversity um certainly being aware of our own language our own implicit bias our own assumptions um is very helpful so what do people need and I'm going to go back real quick so this is needs of survivors and responders right so this is both because as I said before as a responder you are now a survivor notice that we do not use the term victim victim has negative connotations uh if something has been done to you right you're the recipient kind of oftentimes a passive helpless recipient a survivor is someone uh that has experienced something but is overcoming it has uh experienced it and and it is moving through it so you can see just the importance of using language this could okay so this gets back to some of those core actions first thing is to feel safe and secure to have their base have there or your basic survival needs met the ability to tell the story just like we talked about and to reconnect with um the the coping skills that they've used in the past and some and maybe learn some new ones right so because resilience uh what we're doing is we're engaging people's previous resilience skills and resilience not only helps us bounce back and move forward but it builds what we call protective factors um so that the next time something really um intense happens to us or we're have we have a traumatic event or a crisis situation that we have those skills built we know we have those skills built and the way that we approach it is oftentimes can be in a way that um minimizes the impact it may have on us okay so I talked a little bit about this already um so we are what we're looking at here is really connecting to people in a calm manner in an empowering manner uh I once had a professor tell me that if I did nothing else helping people feel hopeful uh was one of the most powerful things that I can do because if people don't have hope then um there really is nowhere to go when you communicate with people who have experience to disaster um using clear language short simple sentences very direct remember memory and problem solving logical sequential tasks become much more difficult that is uh one of the most common reactions that people have after a disaster and so you may have a whole conversation with someone and as a matter of fact I did this once I had this whole conversation with someone I thought it went brilliant I thought my intervention was great I just was made so much sense and um I was feeling really good about myself and at the end of that I asked them so do you understand and they went back and and asked me why I was why I felt it was important to talk about that to begin with so they missed the entire thing I'd only impressed myself uh it was one it was a great learning experience that uh I really just need to keep it short and simple and maybe it's not so much about me maybe it's about them also in communicating because culturally this oftentimes feels very odd um and we don't know what to say when people are experiencing loss or grief or things like that so we kind of come up with some platitudes and so this is just a slide to let you know there's some things that it's better to say nothing than to say some of these things because oftentimes these things feel like what while they sound like they might be supportive is often perceived by that person as minimizing or glossing over the impact of what of of their experience so responder self-care this remember I said this is one of the most important things there are times that you may be asked if you can go respond and that needs to be a decision that you evaluate carefully because there may be things going on in your life that you would not be the best person given the amount of resource that you have engaged or tied up in some things going on in your own life uh for for you to be able to respond because you are going to have to be under uh managing not only your own stress but of the impact of of the people that you're working with as well or that you run across we often have a tendency to what we call have cognitive distortions which is really some psycho babble for we get a little grandiose we often think that um that I you know I I can't leave because there's still things to be done um maybe this other person I'm the only one that understands this um I'm the one that needs to talk to this person because I have a relationship and they these other people they won't understand them as well as I do or they won't be able to help them as much as I do that's a common distortion account of thinking that responders will feel because people that are kind of driven to help others um that's that feels good and when we um can't do that it uh it doesn't feel good when you know when you have to leave and you know it's not done or there's things unfinished or things that you can't help with then um that is difficult so that sense of I can do it better or it's gotta be me uh is just something to be aware of building your own resiliency taking a look at the things that you do the coping skills that keep you centered and manage your stress having a plan and identifying your own resources pre-deployment so have you had this conversation with your family that you may go off and do this or or with your teammates that um during the deployment how how are things impacting you how are people uh your interactions with people impacting you monitoring each other both there and when you get back giving somebody permission to be able to check in with you when you get back responders have a tendency to be a little closed mouth about some of this because other people do air air quotations don't understand because they weren't there that on some level is true oftentimes when you respond in a disaster you develop a very strong relationship um and connection with the people that you have deployed with or respond with because they're experiencing some very emotional emotionally intense things as well as you are and there's a there's a level of of understanding that is present that is not present for people who weren't there be aware of that because that can be a real wedge between um yourself and your friends colleagues significant others spouses when you come back so um having those discussions um both before and after you come back are really important it's really important to to attend to yourself and to um to know when you need to take a break and to be flexible about things my first response was to 9-11 I spent my first two and a half days doing nothing that is very common uh there's a lot of need there's a lot of things that need to happen you can see it you want you might be frustrated that uh these things need to happen and some of you may have experienced this in the past as well um that but you can't get to it because the organizational infrastructure of it is not uh has not been identified or it's not been set up it's very common to um by the time the information gets comes in and the decision is made as to what's going to happen next that the situation has changed so that uh I take cards a book whatever and I learn to be able to take naps and to um not get so frustrated if things aren't going the way that I think that they should a debriefing is uh we require that for for our teams and that is a brief discussion of much like psychological first aid or uh for the responders to kind of put things in order to talk about your experiences to talk about things that may be coming up how you might process that who you want to tell your story to who you don't want to tell your story to um how to to really focus on your own self-care when you get home um those are all really important things for you to do we all know that exercise uh and sleep are really important so attending to those um eating healthy I know I'm starting to sound like an advertisement at this point but it's true all these things are really connected to our mood and to our ability to um to function what are some of the things that you might keep an eye out for um like I said before if if you're someone who uses substances whether it's alcohol or something else cigarettes whatever um to uh to chill out or to calm your nerves or to um to kind of mellow out or whatever you may be prone to continue to use that and may increase use um difficulty relaxing or resting that hypervigilance that we talked about before uh is going to be true so recognizing that that's a common reaction that um that you may be experiencing and you might need to talk to some folks about uh you might have a kind of a large startle reaction to a loud noise or someone stopping by your office or something like that um headaches are are pretty common uh or just a change in activity level so those are common if you find that they're going on for a period of time and they're starting to kind of interfere uh that can be you know that may be something that you just want to talk about you can have a debriefing with someone um or it could be that maybe you're not the person that's recognizing that so one of the things that we often do in post deployment as we plan ahead is to have give give someone permission to bring those things to our attention so that it's um I'm not necessarily going to agree with them but my uh my commitment will be that I will um listen to them and I will at least go and think about it all right so to summarize psychological first aid um addresses those immediate needs the goal is to decrease uh the impact uh in all those five domains the the behavioral psychological emotional cognitive spiritual um domains so that uh that we kind of integrate those experiences uh the emotional part with the logical sequential experience of what occurred uh and that um it lowers the risk of kind of traumatic symptoms traumatic response symptoms as it goes on we're connecting survivors we're empowering survivors we are helping them rediscover um their strengths to stabilize themselves to get their basic needs met reconnect with their social supports and again taking an active role so they they are survivors they are actively working um on overcoming as so no one's doing it for them no one is telling is giving them the message that they can't do it or that we don't believe that they can do it all right and then this is uh what I talked about a few minutes ago and these are um the two website links where someone uh can go and you can actually take the course it's free um looks like you do not uh need a specific log on to be able to do that you can just sign up it's been a little bit since I've been on there myself but I when I looked at these the last time they they were very cleverly done and actually very entertaining as you did it so at that point I am going to open this up to any questions that you might have I think we made it for some lost time and so I was able to get all the content in so be happy to answer some questions great well thank you so much Jody um such a fantastic presentation and really hit on a lot of very important points um for this group to be aware of I want to um encourage you all to drop any questions that you might have there in the chat window I'd also like to ask for the representative from the UW libraries and Henry Art Gallery if you could just quickly type up the list of the folks who are there watching this um with your little viewing party because I just want to make sure that I have all the attendance marked there so if you could do that as well that would be very helpful um but I will say that when we did the debriefings with those members of the National Heritage Responders that we sent to Puerto Rico um to help with recovery efforts after Maria the psychological aspect of their work was something that they hit on over and over again and how important it was to be good listeners and to respect um the needs of the survivors to really tell their story so a lot of what Jody said in this presentation uh echoes with the firsthand experiences of people who are working to help save cultural heritage um so I see Cory is typing a question there so I'm just going to hold tight to see um when that comes through I also want to go ahead Nick this opportunity to thank you all for your patience with the technical issues and Jody I think I was the one who caused the other window to pop up on your screen so sorry about that but thank you for all for holding tight during um the audio issues to start off okay and thank you to the folks at UW um I will make sure that I mark that attendance so Cory is wondering can you address the issue of authority i.e. who is in charge in a pre-disaster situation are the responders giving psychological first aid only those designated somehow and thereby recognized as the authorities or is the psychological first aid for anyone to give if so does that lead to problems of quote who is in charge she might post disaster yeah that's going to ask about that that makes sense um so yeah if you could speak to maybe the authority figures post is uh sure that's a great question so um boy Cory sounds like maybe there's been some involvement in a disaster before so uh this is this is uh this is a truism for uh for disaster response and that is disasters tend to be a political event in in many ways and so um yeah I saw I see that Cory uh and so there is a lot unfortunately you would you in our minds we we think that everybody's just going to come together and help and and everybody wants to do that but systems are set up to to help people but our each system tends to believe that that their way of helping people is is probably the best way and so unfortunately um there tends to be a lot of confusion miscommunication and sometimes some conflict related to um authority so if you are responding specifically as a um responder for for you all as as you uh respond and you have a job to do psychological first aid is really just a method of interacting with the folks around you um if you are responding a as a responder specific to do psychological first aid that typically should fall um as uh you will fall into a hierarchy of folks and there is uh something called NIMS which is the national incident management system um that those of us that that respond do mental health response and things like that um that we have to be trained in that that's there's a whole chain of command that goes and goes into that and so um you have your own role and you also have someone who is designated in charge so so if it's a formal situation like that then there is a designated leadership and deployment however psychological first aid itself is just a means of communicating with people so that you are um you know you can do this informally I find myself using psychological first aid all the time informally uh just with friends or neighbors or you know people that that I know and have communication with and no formal role there so these are just a set of skills that are just really handy I hope that answers your question okay thank you yeah and then um we had a question from um Stephanie at University of Washington who's wondering if you can suggest a short handout on the topic of um psychological first aid I'm assuming are um perhaps this issue broadly for an inclusion in a disaster plan and if you have a favorite so anything that succinctly kind of captures what you discussed today Jody? I don't know that I'm sure there is some shorthand um presentation there somewhere um I'm just not necessarily familiar with uh one off the top of my head there I will tell you that if you if you go and look for the world health organization psychological first aid there's a there's a fairly brief manual online that you can download for free that is very easy to follow and uh there there is I just see Laura here found that there is an app also that you can put on your phone that assists you in walking through psychological first aid thank you Laura I've forgotten about that so I appreciate you bringing that that up I have that actually on my iPad so that I that prompts me so that that's good thank you and another question um from Helen who was noting that um you said several times people need an opportunity to tell their story she says she feels it's also important to let people sit quietly um for those who don't necessarily want to speak um and just wondering if you agree with that sentiment and perhaps maybe some tips on how to handle that kind of silence yes absolutely Helen thank you for um for typing that psychological first aid is really about allowing people to tell their story with with the emphasis on allowing not making or insisting and sometimes people don't want to tell their story and and um let me give you an example that uh that came up so sometimes you may run across people who are sitting quietly and you may come up to them and and and ask them how they're doing or whatever and they may indicate very well that they don't really want to talk to you now there's a difference um if someone's visibly upset or you can tell that something's wrong a simple way to do that is to simply just ask if you can sit with them so for example in a family service center there was someone who was very upset they were very tearful we asked them if they wanted anything um or if we could talk to them they said no so one of my responders just basically said you know i've been standing for a while do you mind if i just sit with you for a minute and that's what they did they just sat in silence silence is incredibly powerful it so happened that in sitting that person decided that they wanted to start talking because they got more comfortable with with the responders presence um but it's it's really about allowing uh we as a society tend to equate doing with uh meaningful and i can tell you one of the the nice things about psychological first aid is it's more about being it is incredibly powerful to be fully present with someone whether you're speaking or not um it's it's it is probably the most powerful gift that that we can give each other and we don't do it very well anymore because we're always on our phones or something like that but don't underestimate to Helen's point um respecting other people or just being physically present and available thank you Helen thank you Helen for raising that question jody for um that very helpful answer um so i'm seeing a little bit of typing happening um okay so gary was just offering a suggestion for some other short resources yeah i would encourage you all to continue to think about um other ways to capture some of this information um and just distribute it because i really do think this is um an important part of the work that you all will be doing as responders but i think it's also important for collecting institutions to consider their disaster plans um this component of the work of responding to events um i realized we're getting close to uh half after the hour so i want to go ahead and just pull over the survey link for this program um again you all probably remember from the first webinar that we did but if you could just click on this link and click the browse to button it will take you to a survey monkey link and if you could just take a couple of moments to complete that survey it'll be very helpful for us um i want to go ahead and take this opportunity now as well to thank jody for this really wonderful presentation um i hope you all found this to be valuable content and i again i'm grateful to you all for your patience with the technical issues um but i will be following up with you all with information about next week's program so we had a little break for a few weeks there but we're hitting the ground running so we've got another webinar coming up in just a week so you all will get an invitation for that shortly um but again thank you all for taking the time and um thanks to jody thank you very much i very much appreciate the opportunity to do this you guys asked some great questions by the way just thanks for what you do and thanks for your interest in this topic so great have a good one everyone