Role of the Counselor in Crisis Response

Running head: COUNSELOR ROLE IN EMERGENCY TEAMS 1

COUNSELOR ROLE IN EMERGENCY TEAMS 15

Role of the Counselor in Emergency Management Teams

Mark Young

Capella University

Dr. Jeri Ellis

Abstract

Crisis counseling is an important part of the counseling profession. Crisis counselors may find themselves as part of an interdisciplinary team ranging from first responders, security personnel, to physicians and law enforcement. Counselors often play the role of a bridge to critical resources and psychological fortitude for those affected by the emergency. Counselors may not be familiar with working in large team settings and must build a skill set that allows themselves to integrate seamlessly into the emergency response team. That immersion includes understanding procedures, policies, and differences between traditional counseling and response team roles. This paper introduces an interview and support of research to help develop ideas about how counselors can project mental health care to communities during emergencies.

Role of the Counselor in Emergency Management Teams

The world is a beautiful yet dangerous place. It is estimated that a community, somewhere in the world, faces a crisis or disaster nearly every day of the year (Sederer, 2012). Research also estimates that one out of five Americans will be affected by some type of emergency situation every year (Sederer, 2012). This paper will provide testimony about the role of crisis counselors in emergencies based on an interview with a mental health professional in the community. In addition to the interview, comparisons will be made between the interview and the Mental Health All-Hazards Planning Guidance (U. S. Department of Health & Human Services [USDHHS], 2003). Finally, counselors’ responsibilities in emergency management and the pre-requisite knowledge, skills, and training for crisis counselors will be reviewed.

Interview with an Emergency Professional

It was a pleasure to interview Ms. Jess Price, who works for the Phoenix Crisis Counseling Network, which is an arm of the Community Partnership of Southern Arizona (CPSA), as a crisis case manager. The interview took place in her office where she greeted me in a warm and inviting manner and offered refreshments. Price started by explaining that regional response teams have been recently used during flash floods, forest fires, and chemical spills in Arizona. While the crisis response teams are important, most of her work is with overwhelmed clients, potential suicides, and are not always related to a disaster or stand-up of a response team (J. Price, personal communication, June 5, 2014).

The conversation moved toward critical timelines. Price noted that each situation was a little different and in her experience response is far from cookie cutter (J. Price, personal communication, June 5, 2014). One important consideration as far as involvement concerns safety. Counselors in her division typically do not begin work until imminent danger is cleared and medical triage is completed (J. Price, personal communication, June 5, 2014). Any individual who is affected is eligible for services and the timelines for services vary depending on the agencies involved and type of crisis (J. Price, personal communication, June 5, 2014). She noted a recent example of a flash flood that killed two people as a good example. A crisis response team was stood up in the flood’s wake and individuals were provided services for roughly a week following the event (J. Price, personal communication, June 5, 2009). Many residents are familiar with flash floods and did not apply for services, there was little destruction, and so first responders were only used for recovery services for the victims (deaths). Counseling was only sought by individuals who knew the deceased (J. Price, personal communication, June 5, 2014). Counseling services are coordinated through the CPSA and typically are offered for about a week following the event. She made sure to note that the 24/7 crisis lines were available and could be called years after an event to deal with latent issues.

Price was asked what important go-to numbers are during a crisis. She responded that she thought the single most important number during an emergency is the proper use of 911 to deal with the immediacy of the situation (J. Price, personal communication, June 5, 2014). After that, the American Red Cross is one of the most influential organizations when it comes to emergency contact and referral communications (J. Price, personal communication, June 5, 2014). Finally, infrastructure services and national response, such as Federal Emergency Management Agency (FEMA), can be valuable. She reminded me that while media portrays FEMA as a major player in disaster at a national level, that most local issues are handled by the State, and local numbers are typically the best help (J. Price, personal communication, June 5, 2014). She also noted that it is incredibly important to not abuse numbers and tie up emergency phone lines for questions that do not concern emergency response. For example, the Red Cross should be called to identify if a family member was affected in a major way by an event (J. Price, personal communication, June 5, 2014). Calling 911 for that type of information can result in wasted resources and increased damage (J. Price, personal communication, June 5, 2014).

The conversation then moved to a discussion about how the media plays a role in disaster recovery. Price noted that local media is often the first source of news to the community (personal communication, June 5, 2009). She was happy with the response, which informed the community of dangerous areas and who to contact if they had major issues (including mental health counseling services) (J. Price, personal communication, June 5, 2014). Price believes that the most important role media can play is providing timely and accurate information about the crisis, mitigation roles, and recovery steps (J. Price, personal communication, June 5, 2014). In addition, she noted that the media can be very valuable in preparation and mitigation by continually keeping top 10 issues in the spot-light. Refreshing the community on what to expect and how to respond to major crisis is an important part of community resiliency (J. Price, personal communication, June 5, 2014).

Price also commented on how she would know if in a situation whose response might need to be escalated. She laughed and said that it was a decision that nobody liked to make (J. Price, personal communication, June 5, 2014). There is a lot of pride in the community taking care of the community. In some cases, a lack of counselors, bed-space, or other resources would trigger a national response. She said there is typically a gut feeling that was really difficult to explain. It can be based on number of victims, number displaced, or number affected. She has not been part of any situations where a national organization such as FEMA was involved (J. Price, personal communication, June 5, 2014). Phoenix is a large city with enough resources to deal with its crises.

The discussion moved toward self-care next. Price mentioned that an intense crisis response can take an emotional and physical toll on counselors. Price recounted that for her, there is an importance in maintaining routine as much as possible. She enjoys meditation, exercise, and eating right to help counter the negative effects of the stress brought out by crisis counseling. Because many crises upend a client and counselor, she noted that it is easy to break a diet and eat a lot of fast food (J. Price, personal communication, June 5, 2014). Being aware of the normal routine is pretty important to being able to maintain that routine. She recounted that the routine (exercise for example) gave her time to recover from a stressful day and help cultivate insight and next steps for challenging clients and situations (J. Price, personal communication, June 5, 2014).

Price used the story of the recent flood to highlight how community organizations worked together in an interdisciplinary team to overcome and rebuild. The local emergency broadcast identified affected areas and media posted updates. State agencies were advised of the situation but help was not requested. First responders attempted to rescue and transitioned to recovery operations. A local command post stood up to coordinate activities between different organizations. Most of the team was on stand-by including physicians and mental health services were on stand-by. It all worked well and coordination is generally quarterly for some aspects and annually for others (J. Price, personal communication, June 5, 2014).

Comparison with the Mental Health All-Hazards Planning Guidance

Price started the conversation by referencing the Mental Health All-Hazards Disaster Planning Guidance as a best practice for mental health service administration and coordination for crisis counseling (J. Price, personal communication, June 5, 2014). The aspects of the All-Hazards Disaster Planning Guide (USDHHS, 2003) are meant to promote public health by integrating services in an effective and efficient way. The document discusses a list of procedures that complement each other and provide in order to create an effective program. Appendix A consists of everything from the purpose of the program, “general assumptions, concepts of operations, organizations and assignment of responsibility, administrations/logistics, to actions like evacuations and mass care” (USDHHS, 2003, p. A-1). Price provided an example of the plan that the CPSA uses, but cautioned it was under revision (J. Price, personal communication, June 5, 2014). The plan the CPSA uses contained all of the areas covered by the all-hazards plan presented in the USDHHS plan. In fact, she mentioned most states follow those guidelines.

The USDHHS was put to the test during one of the biggest disasters to affect the United States, Hurricane Katrina (Disaster Preparedness, 2008). While this was not the first time mental health was part of the contingency response, it was the first time that it was completely overwhelmed (Disaster Preparedness, 2008). It became apparent that mental health had to be more adequately accounted for and become equal partners of the other components of disaster response. One reason that behavioral health has not received as much attention is that psychological trauma and stress is not as visible as broken windows and burned buildings (Disaster Preparedness, 2008). Recent events, more than ever, have put an emphasis on the behavioral health aspects of crises. After the Sarin gas attacks on Tokyo in 1995, the crisis resulted in 5,510 trips to the hospital and nearly 4,000 where psychosomatic (no physiological cause) (Disaster Preparedness, 2008).

The simple fact is that there is a major long-term impact to people exposed to crisis and it requires a thorough and systematic approach. One study in Mexico illustrated this point; people affected by disaster were drastically more likely to have continued medical issues throughout their lives (Norris, Slone, Baker, & Murphy, 2006). In addition, the Center for Disease Control and Prevention produced a study that suggests that mental health issues based on trauma significantly increases the likelihood of mental health and psychiatric disorders (Anda et al., 2007). The belief that taking care of mental health issues close to the source in a comprehensive manner is swelling in popularity (Disaster Preparedness, 2008; J. Price, personal communication, June 5, 2014).

Counselor Responsibilities in Emergency Management

FEMA points to several important responsibilities for counselors in the emergency management process. First and most importantly, FEMA funds counseling including individual crisis counseling to help survivors, psycho-education, group counseling, and assessments (FEMA, 2015). Several very important principles should be supported during crisis counseling as well; first crisis counselors should facilitate recovers, ensure counseling is anonymous (no records), provide outreach in un familiar and non-traditional settings, and supplement community recovery efforts (FEMA, 2015).

Responsibilities for being a team member include strong communication skills. Emergency response teams require coordination between multiple agencies. A counselor cannot simply work in a traditional client-therapist relationship but must also consider ancillary and concurrent actions with other agencies. Thus, traditional team skills including communication, trust, and honesty, are all critical to ensuring positive coordination of behavioral health services during an emergency (FEMA, 2015). In addition, a counselor cannot be learning procedures during an emergency. The time to learn an agencies role is before, not during. Thus, training and education within the local system and local responsibilities are very important.

Skills, Knowledge, and Training Required for Crisis Counselors

Crisis counseling is an important part of counseling because of the high probability that a counselor will be involved in a crisis counseling situation even if that is not his or her primary duty. Minton, Barrio, and Pease-Carter (2011) suggested that crisis issues are a primary concern of many counselors within their work settings. Some programs provide minimal pre-practicum training for students and expect a majority of their training to come in the field during internships that can raise ethical concerns. In addition to training, experience and training are important to integrating crisis counselors into community teams in response to major disasters and traumas in the community (James & Gilliland, 2013). Skills and training should not only be about counseling clients and community healing, but also about working with interdisciplinary teams that help respond to community trauma.

Training

Crisis counselors generally get their initial training through a Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2010) program. CACREP programs have become the standard for licensure in the majority of states for licensed professional counselors (LPC), who generally become crisis counselors. An important CACREP requirement for students in the program is that they, “Understands the principles of crisis intervention for people during crisis, disasters, and other trauma-causing events” (CACREP, 2010, p. 30). Thus, a master’s program is a good introduction to crisis counseling for students who will join the crisis counseling community as licensed professionals. Recent research into the efficacy of the amount of time spent in the program with regard to crisis counseling suggested that the dedicated hours for the topic was sufficient for foundational skills (Henriksen, Van Wiesner, & Kinsworthy, 2008).

Psychological First Aid. Community crisis has effectively stretched the mental health field to the breaking point (McCabe, Everly, Brown, Wendelboe, & Hamid, 2014). Training in psychological first aid can help both professionals and lay personnel in working through community crisis in an efficient and effective manner (James & Gilliland, 2013). Training in methods of “initial contact, rapport building; brief assessment and triage; intervention; triage; referral, liaison, and advocacy; and self-awareness and self-care” (McCabe et al., 2014, p. 624) are critical to the success of crisis program management. This type of training can augment a counselor’s already robust skill set. This type of training can also introduce counselors to inter-disciplinary teams that work in crisis situations.

Skills. Crisis counselors are part of interdisciplinary teams that include first responders, physicians, social workers, and other community representatives (James & Gilliland, 2013). These counselors do not operate in a vacuum, but within these teams and as such, must have strong interpersonal skills. The same empathy, respect, and rapport that crisis counselors use with their clients can be applied to their partners. James and Gilliland (2013) suggested that counseling staples like empathy and rapport are very important in crisis counseling. Crisis counselors do not have the luxury of slowly searching for a presenting problem, latent issues, and ancillary problems that culminate in mental health issues.

James and Gilliland (2013) pointed out specific crisis counselor skills, such as having good self-awareness, being non-judgmental, and having a calming presence. Self-awareness is important because a crisis counselor must be aware of potential triggers (James & Gilliland, 2013). Crisis counselors can lose effectiveness if the trauma and pain from a disaster stir up painful memories or emotions. Empathizing with clients can help can help let the client know that the counselor is there for them when it comes to emotional or traumatizing incidents (James & Gilliland, 2013). Another important counseling skill that is critical in crisis counseling is understanding and providing referrals. While a traditional counselor might prescribe a routine visit to a lawyer or doctor, a crisis counselor may have emergency referrals for time sensitive resources such as food, shelter, and security. A judgmental counselor can inflict additional shame and humiliation on a client. Bad situations happen and a counselor’s responsibility remains being a positive influence on a client’s life. It is important to externalize situations and separate the incident from the person (cite).

Knowledge. Knowledge is the synthesis of training and experience. Knowledge helps counselors create a set of best practices that can go a long way towards helping clients. Knowledge includes knowing and practicing scientifically backed interventions, understanding how to integrate into the communities’ emergency response system, understanding and referring clients to helping agencies, and advanced counseling skills. Knowledge also encompasses skills such as practicing positive self-care and can be facilitated and fostered through continuing education (cite).

Conclusion

Crisis counseling and understanding emergency management response are synonymous. Strong counseling is only part of the equation during a crisis. Understanding how the interdisciplinary team operate, expectations, responsibilities, coupled with skills, training, and knowledge promote effective crisis counseling in major emergency situations. Jess Price provided valuable insight of counseling in such a situation during a recent discussion about flash floods in Arizona and the importance of integrated service delivery. A wide range of skills is necessary and expands traditional counseling skills to emergency response. Counselors may find themselves in the role of a crisis counselor during an emergency response team deployment. The time to learn procedures, policy, and skill is before the crisis strikes.

References

Anda, R. F., Brown, D. W, Felitti, V. J., Bremner, J. D., Dube, S. R., & Giles, W. H. (2007).

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Council for Accreditation of Counseling & Related Educational Programs (CACREP). (2010).

CACREP standards [fact sheet]. Retrieved from www.cacrep.org

Federal Emergency Management Agency. (2015). Crisis counseling assistance and training

program. Retrieved from www.fema.gov

Henriksen, R. C., Van Wiesner, V., & Kinsworthy, S. (2008). Counselor educators’ perceptions

of training requirements. Journal of Professional Counseling, Practice, Theory, & Research, 36(1), 47-57. Retrieved from ProQuest Psychology Journals.

James, R. K., & Gilliland, B. E. (2013). Crisis intervention strategies (7th ed.). Belmont, CA:

Brooks/Cole Cengage Learning.

McCabe, O. L., Everly, G. S., Brown, L. M., Wendelboe, A. M., & Hamid, N. H. (2014).

Psychological first aid: A consensus-derived, empirically supported, competency-based training model. American Journal of Public Health, 104(4), 621-628. Retrieved from ProQuest Psychology Journals Database.

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A national study and content analysis. Journal of Professional Counseling, Practice, Theory, & Research, 38(2), 5-17. Retrieved from ProQuest Psychology Journals.

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Appendix A

Interview Questions

1. In a crisis, are there critical time lines to be considered? If so, what are they?

2. Is there a developmental time sequence to a crisis? If so describe it.

3. Considering a community-wide crisis, who are the local people or organizations that I need to contact? In what order or sequence or time do I do that?

4. Considering a community-wide crisis, who are the state and national people or organizations that I need to contact? In what order or sequence or time do I do that?

5. What helpful or positive role can the local media play in helping to resolve the crisis? How does one facilitate that to happen?

6. Who are the critical players on your emergency management team? Why are they critical?

7. What is the worst eco-systemic crisis you can imagine? Why?

8. What kind of training, education, and experience do you believe should be required to be an effective and competent manager of a community-wide crisis such as the one you described above?

9. Given a natural disaster such as a community-wide crisis, how do you go about coordinating and communicating an effective response?

10. When the crisis situation exceeds your local capacities and resources to respond, how and when do you know who to call for help?

11. Do you believe that current stress reduction procedures, such as CISD for emergency workers, are helpful? If yes, how so, if no, how not?

12. What steps do you take to take care of your own stress and trauma and that of your staff?

13. What are the response team's goals, functions, operations, organizational structure, and responsibilities?

14. Who is in charge of what security provisions?

15. What balance needs to be maintained between security of staff and providing human services?

16. Are there emergency contingency plans for a variety of problems? Do staff members know what is expected of them under varying circumstances?

17. Who is in charge of responding to threats or physical violence?