 All right, again, so thank you so much for joining us for today's webinar, the first of this eight-part series, to complement your in-person training for the Miami Heritage Response Team. These programs are made possible through the generous grant funding support of the National Endowment of the Humanities. Before we dive into the presentation, just a couple of brief technical notes. On your screen, you'll see several boxes including one labeled chat on the left-hand side, which it seems that many of you have found. There's also one labeled web links on the bottom of your screen. So you can use the chat box to say, hello, ask questions, share any information or links that you'd like. If you post a question in the chat box, you'll receive a response either from me or from my colleague Renee at FAIC, who is also joining us for the program. Any questions will be noted, collected, and then I will verbally ask them of our presenter during a break in the presentation. So worry not, any questions will be addressed, but we will just make sure that we do those when there's a break in the content. To use the web links box, click on the link that you want to see, highlighted it in blue, and then you can click on the browse to button at the bottom of the box, and it will take you directly to that website. So Dr. Horseman has been very generous in providing a couple of links here that will help supplement the presentation that she is giving. Before we get started, we've had a couple of poll questions that we would like to ask you all, and of course I've met you all in person at this point, and we've discussed this a little bit, but I think for the sake of this particular topic, it might be worthwhile for us to address, once again, the question of how many of you have actually been involved in responding to a large-scale disaster yourself? So this could be within your institution or if you were working on a larger coordinated response within the region, how many of you have had that experience yourself? So I'll give it just a little bit longer, and I know this is difficult for those of you who are tuning in together as a group, so I know it might not reflect exactly those numbers, but I am seeing that the vast majority of you have not been involved with a large-scale disaster response, so about three quarters to one quarter, shifting a little bit. Let me go ahead and broadcast the results so you all can see that. Great, and if you'd like to comment any more, feel free to do so in the chat window if you have other specific things you'd like to reference in regards to this question. And then one more. Have any of you ever participated in a deployment as a part of a training? So I've done a training where that's involved, deployment. Okay, again, seeing mostly no's for this. Give it just a few more moments. All right, mostly no's. I'm going to broadcast the results so you all can see this as well. All right, this is helpful for everyone to sort of know what people's experiences are, and especially for our presenter, Dr. Horstman, to know where you all are coming from. Great, thank you for that. Okay, with that, I am very pleased to introduce to you all today's presenter, Dr. Jodi Horstman. She's a PhD, HSPP, and a clinical psychologist in licensed clinical addictions council. She has 27 years of experience in community mental health, serving youth, adults, and families. In her current role at Aspire, Indiana, she serves as senior director of comprehensive outpatient 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. These responses includes the September 11 attacks in New York, 2008 flooding in Wabash Valley, Indiana, Hurricane Katrina in the Biloxi Gulfport, Mississippi region, as well as the 2010 earthquake in Haiti. Dr. Horstman was involved with training the team of the 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. Horstman. Thanks, Jessica. Appreciate the introduction. Everybody hear me? Okay, I'm assuming. Thanks again for letting me present. I really enjoy this topic. This happens to be a passion of mine. So whenever I get the chance to either deploy or to speak about deployments, I'm always pretty excited about that. So today we're going to talk about the psychology of disaster situations. Let me give you a little bit of an agenda. So just a little bit about an overview related to disaster. And Jessica was kind enough to send me some information about you all. So I see that there are individuals in the audience who are serving or have served on CERT teams, citizen emergency response teams. I also do some training for our local one here. So I have a lot of respect for the training and investment that individuals bring to that. And I also see that some people have served or volunteered with the American Guard Cross, which also is a great opportunity to get some experience and to really offer some of yourself to those in need. So you may find that some of the information that I give you may have been maybe overlap with some of the training that you've received in some of those endeavors. And actually, I hope it does because there needs to be consistency amongst us as we respond. And I think that's the whole intent. Then we're going to talk a little bit about psychological consequences of disasters, some special population, need of survivors and responders. So just a comment there that we like to say that if you are responding, you are a survivor that many of the things that we're talking about will also apply to you. We like to often think that they don't, but by virtue of responding, you are now in that category. And then some of the guiding principles of psychological first aid, which some of those links will give you some more information. I'll touch on that later and then a little bit about self care before, during and after deployment. So given that, I am going to go ahead and start. So first, I want to talk about resilience, which seems like maybe an odd topic to start with, but it is really important because it is the underlying basis of our interactions with other people and some of our expectations when we go into a disaster situation. So the first thing that we like to talk about is that resilience is really common that many of us have developed the skills to be resilient in terms of the obstacles that have come up in our life. And I like to define resilience as the ability to both bounce back and move forward. So it's not simply overcoming something that's occurred, but also some of the protective factors that keep us from being impacted so negatively as new things come up. So those of us in the mental health field are at a bit of a disadvantage in this because we often misinterpret signs of resilience in people as a reason for concern. And I think that that would be true also for the general population. So, for example, someone may have had a death in the family. And I think this is a frequent response people have and others may kind of watch their response and go, wow, they don't seem to be upset. I wonder what that means or, wow, that person's really upset. It's like way too much. And so we, from our own experience, we have a tendency to put some labels and judgments on other people's response. And so sometimes people respond very resiliently and that lack of kind of falling apart is oftentimes interpreted as, oh, they're in denial or they're just stuffing that away. And it's going to, you know, it's going to come back in and revisit them later. And so we're going to talk a little bit about those things. I have a statistic on here, roughly 50 to 60% of the US population is exposed to traumatic stress. Actually, since I did this slide, I have a new number. So there's actually about 85% of the United States population that will be exposed at some point in their lifetime to a potentially traumatic event. But only about 8% of those individuals will develop the full blown symptoms of post traumatic stress disorder. And I like to point this out because we hear a lot about post traumatic stress disorder. Almost as if because you were exposed to a traumatic experience that it's almost the expectation that you will have symptoms of post traumatic stress disorder. And that's really not the case at all. We bring a lot of resilience into our lives. So let's talk about what are the consequences of critical events because there is a lot of loss. And when I do this in person, this training, I do an exercise. So I'm just going to describe that exercise to you guys so that you can think about it. So I typically ask people to list three people who are very important to them that they are very close to. So three people that you are very close to are very important to you. I then ask people to list three activities, things that you do, activities you engage in, things that are important to you in terms of day to day functioning, things that are important to your family's life, that again are very important. So three activities. And then I ask people to name three things, three objects or some material item that is very important to them. And sometimes people struggle with this one because they're like, oh, you know, I'm not materialistic. But remember, things like this could be photos, wedding photos, photos of a family member who's no longer with us. It could be a family heirloom or something like that. And once people do this activity, so they have nine things listed on their list, what we do is we have them randomly take their piece of paper and give it to someone that they don't know. And I proceeded to in rounds basically ask people to, without looking at the paper, randomly not cross off several items, two items to begin with, maybe then three items. And then eventually that piece of paper gets back to the original owner with maybe just one or two things left on there. And it could be an item and an activity. Maybe all the people are gone or any mix of that. And really what that does is drive home that in a disaster, we do not have control over what is happening. That's part of what makes it a disaster and that we really can't anticipate some of the things that we might lose or how those might affect us. And so we typically kind of have some discussion about what does that feel like to suddenly know that in a particular situation an event may occur and you may suffer these losses. And so on this slide here, we talked about what some of those potential losses are. And I'm going to show you some pictures here from Hurricane Katrina to demonstrate some of those things. The last bullet point on here is the trust in the future. And so I want to talk about that one for just a second because I think that's one of the largest impacts of a disaster on us personally and collectively is that we go through life and we have to go through life with a certain level of denial. Every time you get behind the wheel of your car and you drive on the freeway or the highway depending on where you live in the United States, that's what you call it, every time you get into an airplane, every time one of your loved ones leave home, we are in a little bit of denial about the potential of the things that could happen. And that's necessary for us to be able to function because if we sat and worried about all the different things that could potentially go wrong, we would basically be frozen in apprehension and fear so we have to do that. And what happens in a disaster is that that is stripped away from us, that sense of underlying or the assumption of safety. And so let's take 9-11 as a good example of that. The United States had a certain image of safety as a nation and for our homeland and what the events of 9-11 did for us collectively as a nation was it suddenly stripped that perception away from us. And all the subsequent events and reactions and even the infrastructure we put into place was a result of that, oh my gosh, this can happen to me or this can happen to us. And that is scary and it needs to be recognized because whenever you go into a disaster situation or you may be experiencing a disaster situation, that sense of safety needs to be re-established as quickly as possible as much as possible for things to move forward and for people to collectively heal and move forward. So let's take a look at some examples of this. So this is from Hurricane Katrina and this obviously was a church, a place of worship. And so when we think about who is it or where is it that we turn when things go badly for us or unexpectedly we suffer losses, one of those is typically some kind of spiritual connection or religious community. And so this photo for me represents that that may not be in existence right away. This church obviously is not going to be housing anyone for a period of time. So just something to think about there. When we deployed to Gulfport and Biloxi, we were housed basically on the parking lot of the convention center in Gulfport with army tents and cots. And we were surrounded by a lot of debris obviously, but there was also a hotel that was right next to that that, sorry about that, I heard something, that was destroyed and within that hotel there were people that were killed. And so this slide for me is related to what will you see? What will you smell? What will you hear? What will you experience when you get to the disaster situation? It's really hard to imagine those things. How will you get around? We have a lot of assumptions about well, I would go and do this and I would go and do that. And the bottom line is those things may not happen because there is no, there may be no transportation infrastructure in place for you to be able to get to another place. Where will you find the supplies or food to meet your basic needs? Again, when we pulled into Gulfport, we pulled in at night and found that that it was so dark. I've never experienced such darkness to tell you the truth because there was no electricity. There were no stores. The banks were, you could not access your money. If you did not have money, you didn't have money. There was no going to an ATM. There was no going to McDonald's, all those things. So just think about that. What would that be like when you look around you and try to imagine what that experience might be? So let's talk about what is a crisis? A crisis is really an event or a situation that exceeds the individual's capacity to respond to that particular event at any given moment in time. And I think that that's important to differentiate crisis from trauma. So crisis is very unique to each one of us because we each carry a level of stress with us at any given period of time. So each of us may think about how stressed they are at this particular moment. And I like to use the metaphor of like a teapot. So some of us may be, the water may be very tepid. We're not very stressed or our water, you know, it may be cold that we have, we feel on top of the world today. For others of us, there may be events going on in our life or at our work or just personally that have us at a higher level of stress. Some of those can be pretty large. They could be relationship issues, financial issues, housing issues, other health issues that are the water in our teapot is really already at a simmer, right? So if I'm already pretty stressed and at a simmer and I'm trying to get to work and I have a flat tire, I'm going to respond to that in a manner very different than someone who whose water is cold, right, that they are not stressed out at the moment. And this is really important because I've seen a lot of people, myself included, that you see someone react to something and you're thinking, why is this such a big deal? Why are they reacting this way? Why are they overreacting? And again, a lot of judgment and interpretation about other people. So it's very unique to the individual. A particular event will impact people differently. This is also really important for you to understand for yourself about deploying. So one of the questions that we ask people who are potentially about to deploy is kind of where are you at on that stress scale because it is not helpful for the team to take someone who is already kind of at a simmer or almost at a boil and then putting them in a situation that's going to require a lot of adaptability and flexibility. Those things just don't work well together. So again, something to keep in mind. Okay, so crisis versus a trauma. We know that we all have the potential to be exposed, right, to a traumatic event. But trauma is not so much really about the event. This is really about the individual's perception of and their reaction to the event. So the interesting thing about trauma is that trauma resides in the body and really not so much in the brain. And that's kind of difficult to understand. So let me kind of go into that a little bit. Our brains are designed biologically and evolutionarily to keep us safe. And there are certain things that we react to. So the amygdala in our brain is the portion of our brain that responds with fight or flight to perceived threat. Our brains are designed in a manner that if there is a significant threat or something is perceived as a significant threat to maybe for death or some kind of pain or damage to ourselves or to someone else, that our brains have the ability to kind of circumvent our rational and logical thought in order for us to respond and keep ourselves safe. So what happens when a traumatic event occurs is that there's usually, there's the event and our perception of and reaction to that, which is oftentimes very emotional. And so what happens is that sometimes those emotions kind of circumvent that logical, rational part of our brain and become very embedded in our nervous system. So let me give you an example. If there's anyone in this on this webinar who has ever broken a bone or severely sprained or maybe fractured a limb or extremity, I want you to think about that for a moment. And I want you to think about have you ever then been watching a sporting event or a video or replay and you've seen someone have a similar injury and think about what your response is to that. So I once dislocated my ankle and tore other ligaments in my ankle. And if I see someone sprain an ankle or I'm watching like a basketball game and somebody turns an ankle, my body has a reaction to that. I immediately almost want to curl up. I flinch and there is no logical or rational part of that. That is my body's response to the trauma that it endured. And so that's a physical kind of trauma. But imagine that on a scale of something that's more emotional or includes a physical trauma, such as a disaster. So when that occurs, it really is like a bolt out of the blue. And it leaves us oftentimes feeling very disconnected from that rational and logical part of our brain. And we're going to talk a little bit more about what the consequences of that are and how they affect us. So let's talk a little bit about psychological consequences of disaster. So oftentimes when there's a disaster, there's a lot of media coverage related to that. And it typically focuses on the loss of life or property damage. And that's while very engaging for news channels and viewers, it really is misleading in terms of the impact of a disaster. So what this slide does is really kind of demonstrates there's a medical footprint. There certainly is a medical footprint. So these might be the people that actually were physically impacted by the disaster. Maybe they were injured or there was death. And you can see that this is rather small compared to the circle that represents the psychological footprint. So again, let's use 9-11 as an example. There were a certain number of people who were killed and injured in that attack. The psychological consequences of that attack were nation and worldwide. Those would represent the psychological footprint. I think one of the important things here is that it's that psychological footprint that oftentimes can interfere with the response to the medical footprint. So let's say in your community, there was a large disaster. And maybe as in Katrina, the cell phone towers were knocked out. And so communications were unavailable. Where would you go to find out if your loved ones were okay? Well, typically people either will go to the school to find their children or they will go to the hospital. So here we have what's called surge, hospital surge, where people are flooding the hospital, looking for their loved ones, trying to get some answers, and the people that are actually needing the medical care are unable to get to it. So this is why psychological first aid is so important and why being able to understand the psychology of a disaster situation can help us both anticipate our own responses and what we need to do as well as that from a community standpoint. So here's another example. Let's take the anthrax male attack in 2001. If you think about the number of direct casualties, there were 22. But if you think about those of us that were afraid of white powdery substances or were afraid to touch our mail or the impact on the mail system, you can think of that there were thousands of people psychologically impacted versus or compared to everyone that actually were impacted by that. And terror, again, counts on this, right? That is the intent of a terror attack is it is not necessarily the direct casualties but the psychological consequences of that. So let's look at Haiti. So I put these pictures in here because your response may not always be in an area where there is established infrastructure. So when a team of us went to Haiti, this was a new experience for us. And one of the things that we look for in team members for deployment is that how flexible and adaptive is this person? Because no matter what you believe your experience will be like, it will be different than what you expected. So when I first went to 9-11, when I went to Katrina, when I went to Haiti, it is never the same thing twice. And so what I learned is this, one is that be prepared to sit for a while because disaster response takes a while to get organized. And what happens is that people want to respond, they show up. And by the time the information comes in to be able to deploy that person or that group of people to an area of need, chances are situation has changed and the need is elsewhere. So there is a lot of complicating factors and it is very common and expected to respond to a disaster and have to kind of cool your heels for a little while. And some people have some real difficulty with that because they want to get in there and start helping. And when someone brings that kind of attitude to that situation, sometimes they become the obstacle. So here is Haiti where the expected infrastructure that you would expect here in the United States certainly was not present. These were individuals that were collecting the rebar from the crushed buildings and they were doing it by hand. This is, we were traveling down the street and again no infrastructure. So this is rotting, waste and garbage piled in the middle of the street. And if you look on the other side of that you will see people walking but it is also the marketplace. So this can be a real juxtaposition of what you are experiencing. People are incredibly adaptive so it is kind of amazing to see but part of that is what is your tolerance for negative experiences, for unpleasant experiences. I think probably you have all seen pictures like this. This was a tent city and one of the difficulties with tent cities if you recall is that the safety. So there were certainly people that were unsafe in these cities. There was difficulty with hygiene and bodily waste and difficulty with access to fresh water. You can see that there is a large amount of people crowded together in a pretty small area with no real planning there. Eventually some water was, purified water was accessible to people but again this wasn't you are going to hop in your car and go get water. So when we do trainings on disaster response we like to use this slide. This is a great slide that talks about the impact or the phases of disasters and if you think about this slide this can be true for an individual or a community or in the case of Haiti an entire country. So the line that goes up and down basically represents the functioning level. So you have a basic pre-disaster functioning level. The disaster hits functioning, the ability to go about your life or your community's life on a day-to-day basis is impacted and so you can see the functioning level goes down. Then you see this climb in that functioning level which is referred to as the heroic phase following the impact. And this is where the neighbors, the community, the larger nation, the Red Cross, everybody is rallying to help this community with the impact of the disaster. And so you'll see a lot of fundraising. You'll see people send groups a lot of faith-based groups will send teams in to help with houses or rebuild houses and things like that. FEMA shows up, that type of thing. And so you see this kind of climb in functioning as everybody comes together to assist. And then you reach this level usually, it's usually about a month, you know, maybe a month, six weeks and then what happens always is that all these people that came now have to go home. So you see less attention and the functioning level declines and there's a lot of disillusionment as everybody leaves, the attention is focused somewhere else, and you see actually a lower level of functioning. And then a really actually long time of coming to terms with the fact that there is no quick fix to this, that the recovery is not going to occur quickly. This is a process, not an event, and it will be punctuated by trigger events or anniversary reactions along that way. So who might be psychologically impacted? And these are just some examples of these are the people that are directly impacted, but also think about the ripple effect, right? So certainly those people that were at ground zero were most affected. Their friends, their family, their coworkers were affected, the emergency responders, the people that saw it, but remember that there's a ripple effect outward from that, just like there was across the nation. So think about who might be indirectly affected by the psychological impact of what occurred. So disaster survivors, and you might note that we are consistent in saying disaster survivors and not victims, because that's a real different term. Victim has a rather negative disempowering connotation, whereas survivor does not. It has a more empowering and respectful connotation, and so we deliberately use that term. So disaster survivors experience a broad range of reactions, and these are all, what we say, are normal reactions to an abnormal situation. And to some extent or another, everyone will be impacted in one or more ways related to this. For some, those reactions will last long enough, and the distress will be significant enough that it may interfere with adaptive coping and recovery, and those individuals may need some additional help. So let's talk about what are some of the things, some of the immediate reactions that we might see after a disaster. So cognitively or psychologically, we may see things like and frequently see things like slowed thought processes, difficulty making decisions, difficulty concentrating or solving problems, limited attention span. Behaviorally, we may see things like withdrawal, silence, or excessive talkativeness. Some people will lose their appetite, some people will develop an excessive appetite, some won't be able to sleep, others will want to sleep all the time. We see people that already are having difficulty, maybe with abuse of alcohol or drugs, maybe relying on that coping, that means of coping more so than they had in the past. Emotionally, typically there's a flood of emotions, differing emotions that occur, and this can be pretty frightening for people because what happens is that the flood of emotions is not necessarily tied to anything specific. So we find people that have survived disasters to be doing fine one second, and the next second having a very angry or very tearful response to something and being really concerned that there's something wrong with them. We see irritability, helplessness and hopelessness, and oftentimes a fear of the event reoccurring, especially you see like with an earthquake when there's aftershocks and things like that, that that can that could be a really realistic fear. Physically, we see a lot of headaches, sleep disturbances, flare-ups of pre-existing medical problems as our bodies are trying to cope with this extensive load of stress hormone that's been released, digestive problems, joint discomfort, and then spiritually there's a lot of questioning that goes on following a disaster. People questioning their beliefs and values, questioning the higher power that they believe in, changes in relationships to each other as well as a reevaluation of life structure. So a lot of different things going on. So psychological first aid is really a technique that's designed to reduce that initial distress and you may have either experienced in or had training in in the past, maybe critical incident stress management, which was the initial response and that was designed for first responders. And then as research has gone on, we've discovered that psychological first aid is really the approach of choice. So it is the one that is currently endorsed by the World Health Organization. It is appropriate to developmental levels across the lifespan. So it can be used with children as well as older adults. It can be used in any type of setting. I have used it with people with other languages through translation and interpretation and I found it to be true. It's more reflective of the human experience. It can be informed culturally and adapted culturally. It can be done individually and in groups. So it is also designed not for someone that that's trained in behavioral health. This is really designed for an individual who is not a mental health practitioner and oftentimes mental health practitioners don't do a good job with this because our our training and our assumptions about therapy really kind of get in the way. This is designed for your neighbor, for your church, for your group, your coworkers. These techniques are easy to learn and easy to utilize. So it is adaptive, adaptable and applicable to all these populations. So in a disaster there are always some at-risk populations that you need to take into account. So some of those may be immigrants or people that are here illegally, ethnic minorities that do not speak English, the deaf community, individuals who are blind, others with physical challenges, individuals who are already marginalized. So it could be the maybe the chronically mentally ill or older adults that don't have a good support system or maybe already have some cognitive impairments going on, people living alone that don't have a support system. So you have to think about all these potential individuals and populations as you take these into account. The core actions of psychological first aid are these. And I can tell you right now that the number one is the most difficult. So and that's the making, contacting, engaging survivors because socially we're kind of as a culture, we're not sure what to say. We're not we're not sure how to engage someone. So a quick story about this. We had some flooding in Indiana and I sent a team of actually behavioral health people that I had trained in psychological first aid to the family service center. And when I arrived later I found them behind a table that was with a sign on it that said mental health. And they were of course they're all alone while the rest of the the people, the survivors and people assisting requesting help were elsewhere in the room. And I said, what are you guys doing? And they said, well, no one wants to talk with us. And I said, do you think? Yeah, could have something to do with the fact that you're hiding behind a table. And there's a big sign that says mental health. So really, that making contact and engaging is is just human interaction. It's offering someone a piece of glass of water, or it's holding someone someone's space in line while they can go to the bathroom. It's just asking them how long they've been there. It's just that kind of basic, hey, how are things going for you? Can you do you want to tell me what happened? Just really that offering up of a conversation. I'm not going to go into these specifically because as Jessica noted, I gave you guys a couple of links. And that's really going to give you more information and more in depth information that I can cover in this webinar. So and we'll talk about that again at the end. So again, Psychological First Aid is really just encouraging, respectful listening when people want to talk about their experiences. So it's not therapy. It really is letting people tell their story. And if you think about that, we do that naturally and children do it very naturally. So if something significant happens to a child, you will hear it over and over and over again, because they are processing it and they do that verbally by telling their story. As adults, we sometimes think that that's not okay to do. Like people, you know, I should be able to just get over it. Well, we are social beings and it really works to our advantage when we get to tell our story. So let's say that you came in to work and were cut off by a car on the way in and you had to swerve and you were almost in an accident. Your body is going to respond to that. You're going to be flooded with adrenaline and other stress hormones as your fight or flight response is engaged. You get to work, you're hyped up, you have all this cortisol going on, and the first few people that you run into, you're probably going to say something like, oh my god, you won't believe what happened to me today. I was almost killed, right? You know, this person came out of nowhere and almost drove me off the road and I had to swerve, and it was almost this huge accident. You may tell that story a couple of times, or maybe three, four, or five times. And each time you tell it, the emotion is becoming, is less, and your mind is putting it in more perspective. So it could be that by the afternoon if someone comes in and says, oh my gosh, I heard that you were almost killed this morning, your response will likely at that point be, well, somebody cut into my lane and I had to swerve, but it wasn't like it was, you know, a near-death experience. And that is the natural process of our brains kind of putting these things into perspective. And that's what psychological first aid does because the research indicates that if we can do those things and tell our story and put it into words, that it helps our brain organize that both rationally and attached to the emotion in a rational way and lessens the chance of us having like post-traumatic type symptoms later. Always want to put this in here. So no matter where we're responding, we always want to be sensitive to the diversity of that particular area, that particular group of people, that particular organization. It could be a school, it could be, you know, a particular museum, but there's oftentimes close knit relationships there. We all build our own cultures, our own acronyms in terms of language and things like that. So we want to be sensitive to that and respectful. So let's talk about the needs of survivors and responders. So I mentioned this earlier. The first is to feel safe and secure because unless you have that, you're really not going to move forward. You need to have your basic survival needs met. So that includes food, shelter, and water. They need to be able to tell their story. And one of the first things that happens in a crisis or traumatic situation is that sometimes we forget about the times that we faced real obstacles or challenges in the past and that we've actually made it through those times. Oftentimes with using coping skills that we could bring to this situation, but because of the emotion involved, we've forgotten that. So a lot of psychological first aid is helping people reconnect with their past successes and the ways that they've overcome crises in the past. So the guiding principles of psychological first aid. Again, safety. What we're looking for is to create calmness. So to go in and to be agitated yourself or having difficulty coping with the situation yourself is not helpful to others. So there's a great level of self-awareness here. Sometimes it's not a good idea to respond because of things that are already going on for you. Maybe this isn't the time that you, you know, it's just not a good time for you to be able to do that. And I've had on occasion said, no, I can't respond because there's something else going on. I have another commitment or there's a family situation and there's something like that. And while I love to respond, I also know that it is service to my team to respond when I am going to end up being the object or the focus of their interventions versus those we came to help. We want to connect to others and to foster that connectedness to each other amongst the survivors. Self-efficacy is really the belief in a person's belief in themselves and that they can and they will be able to do something. And so psychological first aid is not designed to do things for people. It's to help people remember, restore those connections to their coping skills and to empower them to take an active role in their own recovery and of course to help instill hope because without hope, why do any of us get up in the morning? If you remember one of the immediate responses to a disaster situation is some level of cognitive impairment, right? So the memory problems, difficulty making decisions, problems concentrating, limited attention span, things like that. So you may find yourself repeating something over and over again. Acronyms are not a good idea. Using clear language, single-step instructions, writing things down is really helpful for people. I've seen a lot of responders get very aggravated with people but didn't I just tell you this? Didn't you just come and ask me this? That is very likely. I once had a what I thought was a great conversation with someone for 30 minutes and at the end of it felt really good about myself and this intervention and she said now tell me again why this is important and that was just a really good lesson to me. Like this really isn't about me and you feeling good about myself. It's really about I just need to be here for that person and we frequently confuse doing and being and psychological first aid and disaster response in terms of that interpersonal relationship it's really about being with someone, being fully present. It's not that you are not going to solve this problem for them, you are not going to make it all better but it is a great honor to be able to sit with someone and to hear their story and to be fully present with them. So some of the things and we put this slide in here because these are things that people often say when they don't know what else to say and and they're really not helpful. So we like to put these in here because we suggest you don't say those things. You were really lucky because of this or you know it could have been worse so and so over here had it worse than you. Again you don't have to make this better. You are not going to fix this. You don't have to have an answer reflecting back to people so you know what I'm hearing you say is this or it sounds like like this has been a really stressful time for you. It sounds like you know it sounds like you're asking for assistance in this. What other questions do you have? Those types of things are perfect responses or can you tell me more about that or I'm really interested in what else you might be experiencing. See those are very benign and those are those are questions or comments that invite the person telling their story to fill in whatever it is that they need to tell you at the time rather than a platitude that is really not going to be received well. So let's talk about self-care for responders. So again we like to think that that we're not impacted by this because we are trained or we're expecting it or because maybe we weren't at the heart of what occurred and what I've found over time is that this just from personal experience that that I'd like to say that because I understand the impact the immediate and delayed impact of disasters on people that I am immune to that but I have found that I am not. So I am 100% behind the comment that as a responder you are now a survivor but we bring a lot of cognitive distortions to that and the more stressed we are the more cognitive distortions that we have. So things like black and white thinking that we lose our ability to see the shades of gray. We start putting a lot of musts and shoulds and things like that into what's occurring. A common responder distortion is that no one can do it better than you. So you can't possibly connect or pass this responsibility off to someone else. People have a lot of struggle leaving a disaster situation when there's still work to be done. It's knowing that you again that you are a small part of this. And I think one of the most difficult things that happened for responders that I didn't understand initially is that all is the understanding that all disasters are political and while on the face of it we're all there to help we all bring our human nature and our history and our funding to this disaster response. And so disasters bring out the best and the worst in individuals. I have seen people rise to the occasion beyond what I can imagine and I've also seen people be so petty that I can't believe that their pettiness was impacting the ability to respond or get some things done and just knowing that in advance and anticipating that and making sure you're not being a part of that is really helpful. Have you developed your own resiliency? Have you developed your own set of skills? And do you have a plan pre-deployment? Do you have a plan to take care of things at work, at home? Have you talked to your partner, your spouse, your colleagues about how things are going to get done so that you are not constantly being pulled in both directions at the same time because when you're at a disaster response you're expected to be fully present. If you are responding in your own community that is even more difficult because it's really easy to overextend yourself because number one you have a lot of investment and a lot of relationships and what's going on but it's really easy to work 14, 16 hours plus a day and not be taking care of yourself or draw the boundary that you think you can both attend to your regular responsibilities and do this. Do you have a plan during deployment? And that would be how do you take care of yourself when you're deployed? Are you making sure that you're eating and drinking and getting enough sleep? Are you communicating your own story? Are you participating in debriefings? And then post deployment is what's your plan? How are you going to explain this to people that weren't there and haven't experienced this? And one of the biggest things that happen when you come back from a deployment to a disaster is things seem to be very crystal clear to you while you're there. You can remove yourself from the day to day responsibilities and details and petty things of your life to really focus and help people and it seems really clear what's important and then you come back to your life. You re-enter your life, your job and there's things that just seem so petty and other people don't realize that they that they're petty. So I remember the first time I came back from deployment was from 9-11 and I came back to work and people were curious and I wasn't sure how to even talk about that. But then I had these job responsibilities and paperwork that needed to be done and I wanted to say don't you know what happened? And why is this important when this is going on? And just know that that is a common response following deployment. So that might be something that you want to talk about with the people you're coming back to. So this is a slide that just talks a little bit about during deployment. These are the things. Again, be flexible. This is a process. Again, not an event. You are not going to be the hero or the savior. You are one piece in a deployment response. Debriefings. We always made sure we debriefed at the end of each day and then when we returned from the deployment and that's really the ability to tell your own story and to give yourself time to process the event and to find someone who will listen to you and let you tell your story. So oftentimes that debriefing needs to be maybe not your spouse or maybe not your family member or maybe not your boss or colleague but somebody else who's objective and can give you that time aside from other responsibilities. These are some of the common stress reactions in responders. For both survivors and responders, as we experience some of the immediate and delayed trauma responses that come with the disaster, even understanding those is different than experiencing those. So knowing what to expect is a huge advantage. However, it still can feel pretty overwhelming and one of the things that we help educate people survivors on is that, again, these are normal reactions to an abnormal situation because people become concerned that they aren't quote normal. They're not feeling or acting quote normal and the more or the I should say the less normal that they feel, the more worried they become that something's wrong with them and the less likely they are to say anything about it, which then exacerbates the whole thing. So it's really about having those conversations up front. These are the things that you might look for that are indicating that that you are having a stress reaction. Does that mean that you have post-traumatic stress disorder? No, it means that you're having a stress reaction. You might need to tell your story. You might need to just be honest with yourself that you need to take more time. You need to go and get back to your own self-care. So to summarize, this is psychological first aid. And what we do, it applies to both the survivors that we serve as well as to ourselves and our corresponders. So you will, as Jessica noted, there is at the bottom two web links. And I just want to talk to you a little bit about what those are before we finish up and take any questions. So the first one is psychological first aid online. And it's through the National Child Traumatic Stress Network. And this is a really actually pretty engaging and interactive way to learn psychological first aid where you it has videos, it's an interactive course for six hours, and it's professionally narrated with activities and video demonstrations and little quizzes to help you pick up these skills along the way. So I highly recommend that if you're interested in maybe learning more about psychological first aid and being able to utilize that in deployment. I will also add that for individuals I've trained in psychological first aid, psychological first aid has a very wide range of applications. So it is not only for disasters, it is very, very helpful in some day to day kinds of events that come up. The second link is to the U.S. Department of Veteran Affairs. And this talks, this has some the psychological first aid manual that you can download with or without the appendices. You can also download the World Health Organization psychological first aid manual. One of the things on this page though that I find interesting is that it has the psychological first aid mobile app that you can download to your mobile device, whether it be a phone or tablet, which is really handy to have should you deploy. There are also some some PDFs for handouts for survivors. And so that you can print off and use as references or handouts for the people that you're working with. So that wraps up the PowerPoint webinar. And so I'd like to I guess open the floor Jessica at this point to see if anyone has any questions or comments. Yes, great. Thank you so much Jodi for that really wonderful content. I just want to remind everyone who is on today's webinar that we have scheduled each of these sessions for 90 minutes with the intention that we would have plenty of time for any questions, comments and discussion. So please do feel free if you have any questions that came up during the course of the presentation to drop those in the chat window. Also if anyone has any personal experiences or you know stories that they might like to share about some of their experiences in responding to a disastrous scenario, I know not too many of you have been directly involved with that kind of response or even just you know a high stress situation where you've seen some of these principles applied. Please do feel free to go ahead and share those. I would just like to reiterate too that since you all are working to with this training to develop a local team, I think that so much of this content is directly applicable. Of course I think a lot of this you should consider in terms of your own psychological condition in working in response but also with your teammates and things to keep in mind and then of course since you are local to that community in Miami in the Greater Miami area, I think what Dr. Horstman said about keeping in mind that you're going to feel pulled in a lot of directions so making sure that you do have a disaster plan at home is going to be of utmost importance to make sure that you are the most effective responder for the cultural community that you can be. So I think there's a lot of good takeaways from here. I'm not seeing too many questions coming in at this point. I have to say this was a very comprehensive presentation so we're very grateful to you for sharing all of this content and I'll go ahead and echo what Jody was saying at the end. The the web links that are available here do have some really great resources that you all should take advantage of in terms of the more extensive training opportunities. So this is an important subject for all of you to be familiar with but if you're especially interested in doing a deeper dive I think those are going to provide some great content there. Madeline Cooper just chimed in saying that she was wondering if you had any tips for helping someone who is in that panicking kind of state who's having difficulty in that moment. That's a good question because we frequently will run across someone depending on where you are in terms of time especially in the disaster response or you could be running across somebody who this is triggered a you know a previous event for them so that's also important. So Madeline thanks for bringing that up. Oftentimes we don't know if this is a reaction to this particular event or like I said this is triggering some historic event for them as well because trauma tends to be cumulative so without knowing that you really just kind of have to address what's going on at that second and so the bottom line is that the person needs to be able to feel safe before you can do anything else so sometimes that entails doing something related to the environment they may need to go somewhere quieter they may need to go go with you to somewhere that's a little more isolated if they're feeling crowded or something like that. I think the responders demeanor the responders tone of voice the volume of your voice is really important here because that any agitation or perceived panic or anxiety from you is going to feed that person's panic so sometimes people will hyperventilate some so I typically will ask people to to look at me in the face to kind of get get down away from people a little bit and just kind of sit and unless unless someone wants to be touched or reaches out to touch you you don't typically want to reach out and touch someone who's panicky because that oftentimes escalates the situation but to speak very calmly smoothly kind of slow your speech down maybe a little bit more maybe a little bit softer ask them to look you in the face keep their eyes on you you might breathe with them have them engage in breathing exercise with you to kind of slow that down so that their body stops responding you may also if they feel if they feel that they're becoming more agitated because of their own heart rate their own breathing and things like that you might even describe what might they might be experiencing from a just a reactive situation you know this is what our body does sometimes that's okay we don't have to necessarily do anything about it we you can control that a little bit by doing these things like it's such as deep breathing closing your eyes maybe and if they want to they may want to reach out and hold your hand or something like that great advice thank you for that and thank you for that great question did anyone have any other questions they wanted to ask of Jodi while we're we're here together i'm not seeing too much else coming in at the moment but i do want to encourage you all to continue to to reflect on this topic and perhaps in one of our subsequent programs we can discuss it further and of course if there's any follow-up questions after the fact do feel free to reach out to me and we'll see if we can connect you to some resources okay well i want to go ahead and take the opportunity now to remind you all that we're going to have a couple of weeks before our next program in the series and then we're really going to get into a groove later in july and august and through september for our other webinars in this series but our next program will be taking place on july 19th which is also a wednesday again at 2 p.m until 3 30 p.m eastern time that topic will be a salvage of books and paper objects and that's going to be with a conservator and national heritage responder randy silverman so we're really looking forward to being able to hear more on that topic from randy i want to go ahead and say a big thank you to dr. horseman for her time today and and preparing the program for everyone so thank you dr. horseman for all of your thoughtful insights on this topic it's it's greatly appreciated and of course thank you to all of oh yes yes thank you to all of the participants for your time today and i look forward to seeing you all in the digital space in a little over a month for our next webinar thanks again thank you