Assistance to Disaster Survivors Crisis Theory & Intervention Raquel E. Cohen, MD, MPH raquelcohendisaster.com/Materials/mini%20co urse5.ppt Module 51.

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1 Assistance to Disaster Survivors Crisis Theory & Intervention Raquel E. Cohen, MD, MPH raquelcohendisaster.com/Materials/mini%20co urse5.ppt Module 51

2 Theory Crisis “Situasi of Crisis” – The organism is in a temporary, state of disequilibrium, precipitated by a stressor characterized as “inescapable”. An intense situation that overwhelms our usual coping mechanisms. Module 52 Definition :

3 Crisis Theory There is disruption of the usual “steady state” patterns… • Biological • Psychological • Cognitive • Behavioral • Interpersonal • Social (emotional fluctuation). Module 53

4 Crisis Theory Past Present AND Future Past Present AND Future Module 54 MAY BLUR… • Predisposing to… • Precipitating… AND • Perpetuating a CRISIS.

5 Crisis Theory • The stressor precipitates an intense situation that overwhelms the individual’s usual coping mechanisms. • A disruption of the usual “steady state” patterns keep fluctuating over time toward a final equilibrium (individual variations): Module 55 • Behavioral • Interpersonal • Social • Biological • Psychological • Cognitive

6 Crisis Theory Post-disaster crisis counseling… Module 56 • Intervensi aktif untuk mengembalikan kapasistas survivor untuk coping dan menangani situasi krisis • Membantu mereka memahami apa yang terjadi di sekitar mereka

7 Techniques in Crisis Intervention: II.Objectives: a)To identify the problems generated by stressors and the difficulties posed by the need for change b)To list alternatives and strategies for action c)To build a decision-making model and develop steps for implementing it d)To operationalize alternatives e)To apply the steps and feedback on results Module 57 CRISIS THEORY & APPLIED PRINCIPLES

8 Techniques in Crisis Intervention: I.Goal of Crisis Intervention: Menguasai perilaku dan coping yang baik untuk memikul beban akibat perubahan lingkungan Module 58 CRISIS THEORY & APPLIED PRINCIPLES

9 Techniques in Crisis Intervention: Guidance…  task-oriented  focus pada “here and now”  komunikasikan: • harapan • perhatian • kepercayaan Module 59 CRISIS THEORY & APPLIED PRINCIPLES Tentang kemungkinan dampak bencana yg terjadi.

10 Techniques in Crisis Intervention:  Keseimbangan anatara istirahat dan kerja  Manfaatkan network  Fasilitasi ekspresi dan pemahaman bahwa emosi yang menyakitkan adalah bagian dari semua fase (normal dan wajar) Module 510 CRISIS THEORY & APPLIED PRINCIPLES

11 Phase-Oriented Interventions Assistance procedures and techniques vary according to the reactions manifested by the survivor. Module 511

12 Fase Bencana & Intervention • Setiap fase pasca bencana ditandai dengan karakteristik dan crisis yang berbeda • Pada fase akut, survivors akan bergantung pada relawan dengan support sistem yang minimal Module 512

13 Assistance to Disaster Survivors Phase-Oriented Interventions TIME PHASES will present differences in:  Intensity  Acuteness  Emergency Module 513

14 Assistance to Disaster Survivors Impact Phase-Oriented Interventions Procedures & Techniques: OUTREACH (stage 1) • Menerima • Mendukung • Mendorong utk bercerita bercerita * Memupuk harapan Module 514 • Menentramkan • Memberi informasi • Merefleksikan • Self- Disclosure

15 Assistance to Disaster Survivors Phase-Oriented Interventions Procedures & Techniques: OUTREACH Module 515  Relawan harus menunjukkan hopeful attitude (perilaku penuh harapan) “… Bersama-sama kita akan bekerja melewati situasi yg menyakitkan ini “ **Ini tidak berarti memberi solusi yg tidak realistis/janji yang tidak ditepati**

16 Techniques in Early Intervention: GUIDELINES: Module 516 Berikan PSYCHOLOGICAL FIRST AID Kenali kelompok yang membutuhkan perhatian khusus  Injured  Contaminated  Bereaved  Intensely exposed  Displaced from home/work  Loss of property

17 Techniques in Early Intervention: Sediakan kebutuhan dasar GUIDELINES: Sediakan kebutuhan dasar Module 517 PROVIDE PSYCHOLOGICAL FIRST AID  Safety  Security  Food  Water  Shelter P R O V I D E :

18 Assistance to Disaster Survivors Impact Phase-Oriented Interventions Procedures & Techniques: PSYCHOSOCIAL FIRST AID (stage 2) Module 518 • Behavioral feeling • Fokus pada hubungan • Pengumpulan informasi • Fokus pada kognitif

19 Techniques in Intervention: Match Intervention To: GUIDELINES: Match Intervention To: Module 519 PROVIDE PSYCHOLOGICAL FIRST AID  Disaster phase  Setting  Survivor characteristics  Needs of the:  Individual  Community  Culture

20 Module 520 The ABCs Turunkan Arousal Facilitate Functional Behavior Support Clear Cognition Techniques in Crisis Intervention: PROVIDE PSYCHOLOGICAL FIRST AID

21 Psychological First Aid Acute phase: Foci of intervention  Arousal:  Arousal: turunkan Ketegangan/excitement  Behavior:  Behavior: bantu survivor untuk berperilaku efektif (jangan terforsir dll)  Cognition:  Cognition: Sediakan informasi yang jelas dan realistis Beverly Raphael MD

22 ABCs of Psychological First Aid  Kenyamanan dan ketentraman  Tingkatkan rasa aman  Reunite families  Tetap bersama keluarga  Kenali survivors yg distress untuk dukungan dan perhatian dini  Sediakan basic needs Module 522 Arousal Source: Raphael, 2000

23 ABCs of Psychological First Aid  Lindungi dari tindankan berbahaya/berresiko  Hubungkan dg support systems  Redirect to constructive, helping behaviors  Bantu untuk mampu melewati pengalaman ini  Reutilize activities  Ajari perilaku adaptif Module 523 Behavior Source: Raphael, 2000

24 ABCs of Psychological First Aid  Berkomunikasi dg efektif  Orientasi pada situasi  Perjelas apa yg terjadi  Beri informasi terkini tentang perkembangan bencana  Beri informasi untuk aksi  Ajak survivor memahami realitas  Identifikasi resiko dan resources Module 524 Cognition Source: Raphael, 2000

25 Long Term Phases & Counseling Mitigating the long-term debilitating effects of post-traumatic reactions through:  Crisis counseling  Consultation AND  Education Module 525 OBJECTIVE OF POST-DISASTER INTERVENTION

26 Techniques in Crisis Intervention: Assisting survivors in organizing and getting to those disasters related services, resources and opportunities that will help them achieve pre- disaster levels of functioning and equilibrium. Module 526 Objective of Post-Disaster Intervention (continued)

27 Assistance to Disaster Survivors Long--Aftermath Phase-Oriented Interventions Procedures & Techniques: CRISIS COUNSELING Module 527 • Reinforcement • Encouragement • Offering insight connections • Clarification • Education • Reality testing

28 Disaster Phases & Crisis Counseling • As time goes by, more resources will become available to assist in crisis intervention and assistance.  Coping capacity will increase &  Stress signs will diminish. Module 528

29 Disaster Phases & Crisis Counseling When assumptions regarding certain predictable events become disorganized, a complex series of responses are selected, depending on the individual’s: Module 529 OBJECTIVE OF POST-DISASTER INTERVENTION • Physiology • Psychology functioning • Feelings about self • Relationship with others