Saturday, June 20, 2009

Noah's CISM Needs

On Wednesday evening, a massive bank of thunderstorms rolled through the Quarterback's former stomping grounds in Pittsburgh, PA. Some reports indicate that up to 3 inches of rain fell in an hour. The damage was massive: there were flash floods, downed power lines, uprooted trees and lots and lots of water damage. The roof of my former synagogue partially collapsed.

I bring this up for two reasons. First, because last night in Ann Arbor, MI we had quite the storm system ourselves and the Quarterback's basement is flooded. Second, and hopefully more relevant to what brings all of you here, is that it raises some interesting issues about crisis response.

Natural disasters that affect large numbers of people are one of the "Big 5" in Critical Incident Stress Management (CISM) [the other four are suicide of a colleague, death on the job, multiple incidents in rapid succession and response after a substantial delay]. These are the ones they teach you about in the Advanced Group Crisis Response class. These are the "don't try this at home" responses.

What makes disasters so complicated? There are a number of issues. First, one of the basic principles of CISM is to remember Maslow's Hierarchy of Needs. If you're not familiar, here's the pyramid. Basically, what Maslow said is that everyone strives for self-actualization, but there are layers that support that and you can't deal with a higher level unless you've dealt with the one below it. People who have been through a disaster are very much rooted in the lowest level. Their physiological needs are threatened. They may not have food or clean water and their shelter is unstable or non-existent.

But CISM works fundamentally at the second and somewhat the third level. We are dealing with the fact that people's sense of safety and security has been damaged, and trying to return them to a sense of love and belongingness. We can't do that work until people's physiological needs are taken care of. People are not ready to deal with their critical incident stress until they are sure they and their family are going to live, they've had a good meal, they have a reasonably long-term place to stay and they've gotten a good night's sleep. Only the first two of those can reasonably be accomplished in a Red Cross shelter.

The second problem with disaster response is that chances are good that if a community is heavily impacted by a storm or an earthquake, most of the crisis responders are affected too. And another of the basic principles of CISM is that you don't respond if you yourself are impacted by the event. Sometimes, the helpers need help.

This is where mutual aid agreements are so important. Those agreements are what will enable members of the Pittsburgh-area teams to combine forces to create whole teams from the bits and pieces of each one that are not personally affected. They will also allow Pittsburgh to call for help from other Pennsylvania teams or teams in other states.

This is also where consistent becomes crucial. If you're going to show up in another town or another state to help out, you have to know that everyone, regardless of where they come from, speaks the same language and is using the same techniques. This is exactly when you don't want some well-meaning therapist or counselor self-deploying and trying to help. Unless they've had specialized coursework, most social workers, psychologists, psychiatrists and counselors -- even those who specialize in treating PTSD -- don't have training in early trauma intervention. And doing it wrong is worse than not doing it at all.


Meet the Quarterback

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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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