Disaster Spiritual CareJust in Time Training

Hurricane HarveyTCRT TRAININGA S OF: 1 S EPT EMBER 2 017

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This is not the ideal training and preparation.

Ideal – plenty of time, group discussion, and questions.

Reality – little time and primarily lecture. Please save questions in order for us to cover the key essentials.

AgendaEncouragement Through Listening

Loss and Grief

Traumatic Stress

Spiritual Diversity

How Can I Serve?

PURPOSE OF TCRT AND DISASTER SPIRITUAL CARE

The Texas Crisis Resiliency Team (TCRT) is a result of the compassion and concern of the Christian faith community for survivors of disasters and other traumatic events. The TCRT is a Christian faith based organization motivated by the teachings of Jesus Christ, and provides emotional and spiritual support to trauma survivors of all religious and cultural traditions. The purpose of the TCRT is to encourage emotional and spiritual resiliency among survivors by assisting them to cope with challenges and restore hope.

MEANING OF RESILIENCY

“The process of adapting well in the face of adversity, trauma, tragedy, threats and even significant sources of stress – such as family and relationship problems, serious health problems, or workplace and financial stress.”

American Psychological Association, “Psychological Help Center: The Road to Resilience,” http://www.apa.org/helpcenter/road-resilience.aspx (accessed October 29, 2013).

MEANING OF EMOTIONAL AND SPIRITUAL CARE

The National Volunteer Organizations Active in Disasters (NVOAD) has a very active Emotional and Spiritual Care Committee.

Emotional Care Providers– focus on emotional well-being. Normally licensed social workers, counselors, psychologists.

Spiritual Care Providers – focus on meaning and faith. Often community faith leaders.

Distinction is often blurred. Faith leaders are sometimes social workers and counselors. Social workers, counselors, psychologists are often people of faith interested also in spiritual well-being.

NVOAD POINTS OF CONSENSUSDISASTER SPIRITUAL CARE

“Spiritual care providers demonstrate respect for diverse cultural and religious values by recognizing the right of each faith group and individual to hold to their existing values and traditions . . . Disaster response will not be used to further a particular political or religious perspective or cause – response will be carried out according to the need of individuals, families and communities.”

National Volunteer Organizations Active in Disasters, “Disaster Spiritual Care Points of Consensus, 2009,” accessed August 15, 2016, http://www.nvoad.org/resource-center/?mdocs-cat=mdocs-cat-62&att=null.

DISASTER SPIRITUAL CARE AS MINISTRY OF SERVICE AND ENCOURAGEMENT

Direct result of the ministry of the church to the community.

Based upon the teachings of Christ

• John 13: 1-17 – The towel as a symbol of service

• Luke 6:36 and Galatians 6:2 – Christians are to bear one another’s burdens and be compassionate.

• 2 Corinthians 13:11 – Encourage one another

VALUE AND LIMITS OF DISASTER SPIRITUAL CARE

There are many needs of a disaster survivor – Physical, financial, relationships, health, and spiritual. All must be addressed.

Disaster spiritual care is not done alone – all the needs must be addressed. All the needs are important

Knowing our role – Spiritual needs are the focus of our assistance. People cannot recover if they are discouraged and have no hope!

Crisis Intervention – not long term counseling or pastoral care.

◦ First Aid is a good analogy. First Aid serves to stabilize the person and those needing additional help go to the hospital.

◦ Disaster Spiritual Care – goal is to help the person emotionally and spiritually thru the immediate situation. Others will provide long term therapy and counseling as needed.

SPIRTIUAL CARE PROVIDER – WHO?

Someone who is:• Spiritually Fit and Morally Straight: That is a Boy Scout phrase, but it fits.

• Compassionate and Caring Person

• Listens well to others

• Will respect people with different religious and cultural traditions

We do want ministers, chaplains, social workers, counselors BUT you do not need to have those qualifications to be a good Spiritual Care Provider.

EncouragementThrough Listening

TCRT TRAINING

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PURPOSE

•To better understand the needs of trauma survivors that impact the communication process.

• To enhance our listening skills to better assist trauma survivors.

• To provide encouragement for the trauma survivor.

To answer before listening – that is folly and shame.

-- Proverbs 18:13

The instant people perceive disrespect in a conversation, the interaction is no longer about the original purpose – it is now about defending dignity.

-- Kerry Patterson, et. al.

THE NEEDS OF THE TRAUMA SURVIVOR

• Communication style with trauma survivors focuses on their needs and not the need to solve a conflict or get a point across.

•We are doing crisis intervention and not counseling or therapy.• Spiritual First Aid

• The attitude of the Spiritual Care Provider is crucial for good listening.• It is about their needs and not our needs.

• Maslow’s Hierarchy of Needs serves as a model to help understand the trauma survivor.

Maslow’s Hierarchy of Needs

AWARENESS OF NEEDS:OBSERVATION

• Anticipate the survivors situation – part of planning.

• The primary needs and level of conversation will usually focus on physiological and safety needs.

• Observe the situation and be aware – this is often a quick assessment.• What is their physical situation?

• Are they in a safe environment?

• Does someone appear to be in charge?

• Are there language or cultural issues?

• Observe non-verbal language.

Barriers to Listening

• Having a pre-set agenda.

• Physical Environment – unable to hear clearly.

• Language and cultural differences.

• Need to solve problems.

• Need to be doing something.

COMMUNICATION PRINCIPLES FOR DISASTER SPIRITUAL CARE

• Communicate Safety.

• Communicate Respect.

• Communicate Concern.

• Communicate Encouragement.

COMMUNICATE SAFETY

• In the immediate aftermath of a trauma, the environment might be difficult to control. There might be little privacy. The conversation might be in a public location.

• Control what you can to private maximum privacy and comfort.o Try to find place where people can sit and relax.

o When possible find a place where the conversation can be more private.

• Clarify guidelines for confidentiality.o Confidential except if there is threat of harm to self or others.

COMMUNICATE RESPECT

• Empathy NOT Pity

•Validate – not the same as approving.

• Don’t Judge• Not agreeing

• Not disagreeing

• Cautious with humor – OK for them to use. NOT OK FOR CRT MEMBER.

• Apologize when needed – if you think you might have offended“I am sorry, I did not mean to offend you.”

ALLOW THEM TO SET AGENDA

• What do they need?

• Don’t try to solve problems – not the same as sharing information. Sharing needed

information is appropriate.

• Don’t interrupt – there are some exceptions.

• Don’t tell your own stories.

• Don’t talk too much – if your are doing most of the talking, then something is wrong.

COMMUNICATE CONCERN

The technique utilized by Coaching Style is helpful, because it does not focus on the agenda of the Coach, but on the needs of the one being coached.

• Ask open ended question – Who, What, Where, Howo Do not force people to talk.

o Allow them to share what they want to talk about.

• Validate: Communicate that you are hearing them.o Do not repeat (or parrot) the exact words of the trauma survivor.

o Build upon what they have said using some of the same words.

• Never ask Why questions – it puts people on the defensive.

QUESTIONS THAT INVITE PEOPLE TO SHARE

The questions are always based upon what the trauma survivor is wanting to talk about so there are not prescribed questions to ask…just a basic approach.

Instead of a Yes/No question such as: “Are your children OK?” Ask: “You mentioned that you concerned about your children, what concerns you the most.”

Instead of: “Did you receive any assistance?”Ask: “What have your found to be of assistance?”

Instead of: “Is there any other way we can help?”Ask: “What are your greatest needs for assistance?”

COMMUNICATE ENCOURAGEMENT

• Share appropriate information based upon their concerns.• If they have had a loss, share about what reactions they might expect.

• If they need information on insurance, share where they might find that information.

• Good to have a pamphlet describing the grief process … best not to give a lecture.

• Encourage to use helpful resources including government, local organizations, and faith.

• Do not make promises that you cannot keep.• “If you have any problems, just call me.” INSTEAD “If you have difficulty with this, there are several

places where you can turn to for assistance.” Give them where and how to contact those resources.

Disaster Spiritual Care

Loss and Grief

TCRT TRAINING

Purpose

• To identify when a survivor experiences loss and grief.

• To understand the dynamics of the grief process.

• To identify how to help survivors with their loss.

The LORD is close to the brokenhearted and saves those who are crushed in spirit.

-- Psalm 34: 18

It is not just about knowing the stages. It is not just about the life lost but also the life lived.

◦ -- Elisabeth Kübler-Ross

Disasters:

• Always mean chaos and loss.• Disaster response seeks to help the individual move from

the chaos of their old life into a new order in their new reality.

• Loss is the human impact of a disaster• Grief is the human response to that loss.

SURVIVORS NEEDING ASSISTANCE

Group 1: Previous depression, trauma, or psychiatric diagnosis.

Group 2: Health or mental health risks: high blood pressure, issues with anxiety, those with marital problems, and with issues related to drugs or alcohol usage.

Group 3: Coped well in previous situations, but now need help after a significant disaster.

Groups 1 and 2 are complicated grief situations and Spiritual Care Providers should refer to mental health and medical professionals.

Spiritual Care Providers can provide the most assistance to Group 3.

James W. Ellor and Sara Dolan, “Lessons Learned from Disaster Behavioral Health for Social Workers and Congregations,” Social Work and Christianity 43, no. 1 (2016): 108-126.

Dynamics of Grief Physical Impact

• An emptiness inside

• Tight feelings in chest and throat.

• Sensitivity to noise or smells.

• Everything seems unreal.

• Shortness of breath.

• Generally weak all over.

• Lack of energy.

• Dry Mouth.

Some symptoms may indicate serious medical situation and medical attention maybe required.

Richard A. Kalish, Death, Grief, and Caring Relationships, 2nd ed. (Monterey: Brooks/Cole Publishing Company, 1985), 186.

TASKS OF GRIEF

Task 1 To accept the reality of the loss.

Task 2 To work through the pain of grief.

Task 3 To adjust to an environment in which the deceased is missing.

Task 4 To emotionally relocate the deceased and move on with life.

Worden, J. W. (2002). Grief Counseling and Grief Therapy (2nd ed.). New York: Springer Press.

WAYS TO HELP

• Presence.

• Listening.

• Faith.

• Assistance of others.

Loss and grief are an underlying theme of all the training modules of Disaster Spiritual Care. Spiritual Care Providers must integrate and utilize all the skills learned from the other Disaster Spiritual Care modules.

Disaster Spiritual Care and Traumatic Stress

TCRT TRAINING

Purpose

• Distinguish between stress and traumatic stress.

• Understand possible impact of traumatic stress.

• Identify when and how to refer trauma survivors for additional assistance for stress reactions.

Do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you.

-- Isaiah 41: 10

Despite the human capacity to survive and adapt, traumatic experiences can alter people’s psychological, biological, and social equilibrium to such a degree that the memory of one particular event comes to taint all other experiences spoiling appreciation of the present.

-- Bassel A. van der Kolk and Alexander C. McFarlane

Traumatic Stress

• Traumatic stress involves a threat to one’s physical or emotional well-being. Fear is a major factor in traumatic stress.

• Traumatic stress includes time-limited events and long-lasting exposure to traumatic events.

• Traumatic stress has an impact on the brain of traumatized individuals.• Traumatic memories associated with trauma may be forever.• While often controlled the memories may reemerge when personal control is reduced.• Normal stress management may not be effective.

Arieh Y. Shalev, “Stress Versus Traumatic Stress from Acute Homeostatic Reactions to Chronic Psychopathology, in Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society.

Traumatic Stress

• Not everyone experiencing a traumatic event will be traumatized.• People vary in their reaction for a variety of reasons.

• Realistic training designed to help people cope with specific events may help reduce the traumatic stress of those type events.

• Those not traumatized may find normal stress management skills adequate.• Listen to the trauma survivor and allow them to identify their reaction.

• Allow them to decide if their normal stress management resources are helpful.

Post-Traumatic Stress Reactions

• There are various acute stress reactions, the most well known is Post-Traumatic Stress Disorder (PTSD).

• Everyone experiences post-traumatic stress reactions – but most people do not develop PTSD.

• PTSD is a diagnosed psychological condition that can only be diagnosed by a qualified profession.

• Spiritual Care Team Providers as members of the CRT do not diagnose or treat PTSD.

Alexander C. McFarlane and Rachel Yehuda, “Resilience, Vulnerability, and the Course of Post-traumatic Reactions, in Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society.

Frequent Post-Traumatic Reactions

•Difficulty concentrating

•Flashbacks

•Reacting to similar circumstances

•Guilt

•Anger

•Sadness

•Sleep disturbance

•Eating disorders

•Trouble with routine tasks

•Difficulty with religious practices

•Relationship withdrawal

•Difficulty being alone

Post-Traumatic Stress Disorder (PTSD)

• When post-traumatic reactions persist and cause problems with work and relationships, trauma survivors should seek professional assistance.

• There is a great deal of research and work being done on improving treatments for PTSD. Trauma survivors can get assistance and control post-traumatic reactions. They do not need to silently endure. There is hope!

Role of Spiritual Care Provider

• Know Limitations

• Provide Encouragement and Spiritual Support

• Focus on Resiliency

• Refer When Needed

• Practice Good Personal Stress Management

Disaster Spiritual Care and Spiritual Diversity

TCRT TRAINING

9/1/2017

PurposeIncrease the ability of the Spiritual Care Provider to respond to the religious and

spiritual needs of trauma survivors by:

• Assessing the spiritual needs of trauma survivors.

• Understanding how spiritual and religious beliefs can help or hinder resiliency.

• Understanding how trauma impacts a person’s understanding of their spirituality

and religion.

• Understanding the appropriate utilization of our spirituality in responding.

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Do not forget to show hospitality to strangers, for by so doing some people have shown hospitality to angels without knowing it.

Hebrews 13:2

Real tolerance and respect for diversity requires that we figure out how we should deal with ideas, behavior, and persons we genuinely disagree with, some of which we believe to be no simply different but wrong.

D. A. Sherwood

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Spirituality and Religion

People can be “spiritual but not religious”

Spirituality –• Associated with meaning, purpose, values, beliefs, and ethics.

• Encompasses the whole of human life and will develop in a variety of styles, depending on cultures, denominations, personalities, and gifts.

Religion –• Patterns of spiritual beliefs and practices formed and maintained by a

community.

• Associated with organized institutions and traditions.

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Number of different belief systems makes it impossible to be knowledgeable on all groups.

One study lists:• 19 Major World Religions• 270 subdivisions of the World Religions• 34,000 separate Christian groups with no larger denominational association.

Helpful to learn as much as you can in order to prepare for religious needs.

Allow trauma survivors to identify their needs.

Ontario Consultants on Religious Tolerance, “Religions of the World,” accessed October 3, 2016, http://www.religioustolerance.org/worldrel.htm.

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Assessing Spiritual Needs

• Coordinate with Case Workers to obtain relevant assessment information.

• Observe the presence of religious symbols that might indicate religious affiliation.

• Make comments or ask questions that will allow the trauma survivor to talk about their religious or spiritual needs.

• If you offend – apologize!

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Identify Religious and Spiritual Needs

Needs may include:

• Access to religious worship.

• Access to sacred scripture and texts.

• Access to food that meets a person’s religious needs.

• A multi-faith sacred space that can be used for meditation and prayer.

• Appropriate timely religious care to the dead.

Work thru the TCRT team leader to help meet unmet religious and spiritual needs.

Stephen B. Roberts and Willard W. C. Ashley, Sr., eds, Disaster Spiritual Care: Practical Clergy Responses to Community, Regional and National Tragedy (Woodstock, VT: Skylight Paths Publishing, 2008), xvii.

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Questions of Faith

Reconsidering core tenants of religious beliefs.

Asking questions such as “Why did God do this?”

Questioning justice and meaning.

Feeling far from previously held beliefs.

Feeling a need to be cleansed.

Closing oneself off from loved ones.

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Feeling despair and hopelessness.

Feeling guilty.

Wondering about life and death.

Feeling shame.

Roberts and Ashley, eds., Disaster Spiritual Care, xx.

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• The Spiritual Care Provider needs to have dealt with difficult issues such as theodicy before responding to disasters.

• Respect the need of trauma survivors to search for understanding in the midst of confusion.

• Validate feelings and words of trauma survivors.

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Spirituality and Religion as Helpful

• Assist trauma survivors to utilize their faith as a source of hope and encouragement.

• Do not correct the perceived wrong beliefs of trauma survivors.

• Examine potentially harmful statements and get additional assistance if needed.

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Spirituality of the Provider

• Prayers with trauma survivor

• Scripture and Religious literature – If you are going to provide one type of religious literature you need to allow / provide from other groups. Respond to their need.

• Sharing of Personal Beliefs

• Spiritual well-being of the Provider

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Special Issues

Dealing with the various questions

What about when you think their answers are WRONG

Can you pray? When and How?

Worship services?

Other concerns.

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How Can I Serve?

TCRT TRAINING

A S OF: 1 SEPT EM BER 2017

Ways to Help

For Hurricane Harvey Shelter Ministry:• Based on the needs of survivors and staff at the shelters.

Language Needs

Hearing Impaired (ASL)

• Number of shelters operating – been constantly changing3 Shelters on Thursday, 31 August

1 Mega Shelter on Friday, 1 September

• Spiritual Care Providers Chosen Selected to Served Based on:AVAILABILITY – Often the most qualified are not available. Chaplains, Pastors, Counselors often are working other jobs and have limited availability.

Often cannot get special language needs met. THIS IS A BIG PLUS WHEN WE CAN!

Ways to Help

Other Opportunities to Help Hurricane Harvey – THERE WILL BE MANY NEEDS FOR SPIRITUAL CARE PROVIDERS:• With other teams – this training will help you, but each organization has there own training

requirements. Texas Baptist Men (Yellow Cap, Chaplain, etc), UMCOR (Methodist), Presbyterian Disaster Assistance, and many more.

• Look for the opportunities and they will be there!

DO NOT SELF-DEPLY USING THE TCRT BADGE AND SHIRT!• All responses must be approved.

• Maybe just an e-mail to the Director of TCRT saying there is a need here and I’ve been asked if we canprovide Spiritual Care.

Future Ways to Help

• Utilize insights from training in daily ministry opportunities – It is a “Ministry of Encouragement” and there are always opportunities to encourage others.

• Future Disaster Response –• Keep engaged – keep badge current and a shirt available.

• Take additional training –

• Texas Crisis Resiliency Team - http://texascrisisresiliencyteam.org/

• Participate in Disaster Exercises and Planning

• The ones turned to first in a disaster are those who are involved before the disaster!