Populations with Special

Considerations

* Midwestern Regional Training * May 4 – 6 * Chicago, IL

Possible Populations with Special Considerations

• Children

• Elderly/middle-

aged

• Disaster workers/first

responders/

medical staff Trauma survivors

• Ethnic/cultural groups/minorities

• Immigrants & migrant workers

• Refugees• Individuals with

disabilities (medical and behavioral)

Possible Populations with Special Considerations (cont.)

• Victims of domestic violence

• Families of first responders

• Media

• Victims who have become disaster workers/first responders/

counselors• Clergy/spiritual

leaders

Training for Work with Special Populations Includes:

• Competence in listening and communication

• Assessment that is appropriate to the population

• Established interventions to reduce distress

• Full understanding of the context to determine the appropriateness and feasibility of specific interventions.

Incorporating Populations with Special Considerations into

Disaster Planning

• Involve key members of each special population within an advisory group or Disaster Planning Consultation Board

• Identify specific needs as perceived by community members for inclusion into disaster plans.

• Manson, S. Health Care and Older Ethnic Minorities: A Guide for Integrating Culture and the Clinical Process. Denver University of Colorado Health Service Center for Needs Assessment Study, 1995.

Collaboration with Existing Local Resources• Local resources may help staff to understand

indigenous perceptions of suffering, illness, loss, pain, and healing

• Collaboration with traditional healers is important

• Local leaders may help to endorse the program and identify solutions to problems

• Local leaders may help to build or rebuild social support networks, and act as “cultural brokers”

Cultural Sensitivity, Competency, and Diversity in Disaster Behavioral Health Services

Sensitivity:

Being aware of the various cultural groups affected by the disaster. This includes ethnic and racial groups hardest hit by the disaster, language barriers and attitudes towards “outsiders,” including the government

Cultural Sensitivity, Competency, and Diversity in Disaster Behavioral Health Services (cont.)

• Competency: Being aware of one’s own values, attitudes, and prejudices; being committed to learning about cultural differences; and being creative, flexible, and respectful of others’ values and beliefs in interventions and outreach approaches

• Diversity: Includes social class, gender, race, ethnicity, and lifestyle.

Recommendations for Working with Populations with Special Considerations

• Utilize culturally competent skills

• Utilize the population with special considerations as disaster workers/first responders/ medical staff

• Assess community members and individuals for relevant cultural and traditional mores.

Manson, 1995

Recommendations for Working with Populations with Special Considerations

• Learn some of the language, at least the commonly used words.

• Find a mentor who is known to the community

• Enlist key members of the community

• Use a natural setting to collect information – go into the community

Manson, 1995

• Meet with special population members to identify specific needs of the community

• Learn more about the native healers-or the general way the community uses and accesses health care

Recommendations for Working with Populations with Special Considerations

Manson, 1995

Recommendations for Working with Populations with Special Considerations (cont.)

• Learn all about the community, strengths and weaknesses

• Use the communication style of the community

• Maintain your awareness as you work with a special population.

Manson, 1995

Values Intrinsic to Working with Populations with Special Considerations

• Respect the needs, resources, and strengths of the person and community

• Ensure staff is grounded in knowledge of care appropriate for disasters

• Recognize the legitimacy of multiple perspectives on trauma and related concerns.

Danieli, Y., et al. Guidelines for International Training in Mental Health and Psychosocial Interventions for Trauma Exposed Populations in Clinical and Community Settings. Task Force on International Trauma Training of the International Society for Traumatic Stress Studies, 20k02

Values

• Address cultural issues within the training and management of the program

• Allow indigenous structures to take a leadership role over time in directing the process; psychosocial interventions may not be effective if not supported by a stable social environment

• Ensure that personnel are practically and mentally prepared for conditions in the field.

Danieli, 2002

Values, cont.

• Keep in mind that every client or victim may be a part of a population with special considerations

• When appropriate, utilize members of a population with special considerations as examples of resilience

• Use the population’s resources

• Be non-conventional

• Include rather than exclude Danieli, 2002

Intervention Strategies

• Learn local norms from community leaders

• Use bilingual and bicultural staff

• Allow time to gain acceptance in a community

• Be dependable, non –judgmental, respectful.

Adapted from CMH Disaster & Crisis Mental Health Populations with Special Considerations presentation.

Intervention Strategies, (cont.)

• Recognize cultural variation in expressions of grief or trauma reactions

• Recognize varying cultural acceptance of mental health interventions

• Provide community education information in multiple languages

• Focus on problem-solving and concrete solutions

Populations with Special Considerations

Ethnic/Cultural GroupsMinorities

Importance of Cross-Cultural Competency• The population of the United states is

becoming increasingly diverse

• In year 2000, 25% of the U.S. population was classified as minority

• By year 2050, it is predicted that more than 50% of the U.S. population will be from a non-European background

U.S. Dept. of Commerce (2001), Current population survey, 1998, 1999, & 2000, Washington, DC: U.S. Government Printing Office

Ethnic/Cultural Groups/Minorities

• Cultural differences lead to different health-seeking behaviors

• Tendency for more physical complaints as expressions of psychological distress

• Stigma toward mental health/substance abuse

• Previous exposure to trauma may worsen coping with current trauma

• Difficulty navigating benefit system.

Factors of Ethnic/Cultural Groups/Minorities Influencing Disaster Response and Recovery

• Dominant language used within households

• Family structure

• Willingness to access services

• Location of services

Adapted from CMHS Disaster & Crisis Mental Health PopulationsWith Special Considerations presentation

Basic Principles in Working with Ethnic/Cultural Groups/Minorities

• Use bilingual and bicultural workers

• Access to trained interpreters

• Maintain awareness of immigration experience and status

• Identify and utilize family values and support systems

• Be cognizant of cultural values and traditions. Adapted from CMHS Disaster & Crisis

Mental Health PopulationsWith Special Considerations presentation

Adapted from CMH Disaster & Crisis Mental Health Populations with Special Considerations presentation.

• Recognize & respect differences

• Understand cultural definitions of behavioral health, well-being, coping, and recovery

• Provide services and information in primary languages.

Basic Principles in Working with Ethnic/Cultural Groups/Minorities, (cont.)

Populations with Special Considerations: Refugees

• 35 million people forced from their homes by violence & repression

• 21 million internally displaced• Number of countries producing massively uprooted populations doubled• 2,000,000 + refuges in

U.S. since 1980; 72,515 admitted in FY 2000

Populations with Special Considerations

• Individuals with Disabilities• Individuals with mental illness

– May worsen preexisting conditions– New trauma may exacerbate existing history

of trauma– Loss of social support– Interruption of treatment– Cannot navigate benefit structure

• Individuals who are homeless– Preexisting problems with social support– Concomitant problems (medical substance abuse, psychiatric).– The most vulnerable are hurt worst in most disasters– Easily overlooked and already marginalized.

KEY CONCEPTS TO REMEMBER

• The target population is normal

• Avoid behavioral health labels

• Be innovative in offering help

• Fit the program into the community

• Be aware of the cultural differences of each special population.

Adapted from CMHS Disaster and Crisis Mental Health Populations with Special Consideration presentation

KEY CONCEPTS TO REMEMBER

• Strategize on how to access your populations with special considerations

• Invite the “cultural broker” of the community or each population with special considerations to participate in planning

• Be aware of gaps in intervention and service to populations with special considerations

Adapted from CMHS Disaster and Crisis Mental Health Populations with Special Consideration presentation