November is NaBloPoMo: Who Knew?

Hurricane Sandy

This week was the anniversary of Hurricane Sandy.  As expected, there was considerable news coverage.

One reason that I have not posted in a while?  It’s hard to articulate the sadness I feel for those still suffering.

Until today, I had never heard of National Blog Posting Month (a.k.a. NaBloPoMo).  It’s goal?  To get people like me to post every day during the month of November.

I don’t feel up to daily posts. Nonetheless, I invite you to stay tuned to see what happens.

More importantly, share your reactions about this week’s coverage and the stories of Sandy’s impact. There is a special below box for this purpose. It’s labelled “Comment. Question. Share”.

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September 11, 2014–A Teachable Moment

Education, Evacuation, Hurricane Sandy, Personal Preparedness, September 11th, ,

September 11th will always be a day of mourning. How do we want to commemorate it next year?

Here’s an idea: Why not use September 11th to learn about evacuation?  Many people never stayed in a shelter and don’t  know where the nearest shelter is.

Many people do not have a go bag. If they have a go bag, they wonder what to put in it. Is it better to omit some items and have a lighter bag? Should they pack more and not worry about the weight of the go bag? (Yes, it’s like preparing for an overnight hike!).

It’s unrealistic to expect most people to figure out go bags and evacuation on their own. Who wouldn’t welcome some expert, communal hand-holding?

For starters, evacuation shelters are usually set up in a school. The shelter nearest you might be in an elementary school, a middle school, or a high school. It might be in a community college or a four-year college.

However, evacuation shelters are not always in a school. The shelter nearest you might be in a community center, a recreation center, or a house of worship.

“Find Open Shelters” is  part of the wonderful work done by the American Red Cross.  Just before or during an emergency, it tells you which shelter nearest you will be open.  If another disaster occurs, do not assume that the location used during Hurricane Sandy will again become a shelter.

September 11th provides a teachable moment.  On or near September 11th, 2014, experts in emergency management should hold free, community-wide events.  These events might be held where evacuees were housed during Hurricane Sandy.

Folks will then–while not under special stress–find the evacuation center and learn about it. Is it in the middle of nowhere? Is there a library nearby?  Is there a pizza place within walking distance? 

Is the evacuation shelter clean and well-maintained? Is it dingy and depressing?

Is there parking? Are buses or a train station nearby?

Participants who have go bags should bring them. They can compare items in their own go bag with what their friends and neighbors have. Hopefully, participants without a go bag will be inspired to pack one.

The idea of connecting September 11th and personal preparedness can be adapted. For example, the meeting could be held at a library or a high school instead of at a shelter.

I always feel a connection between September 11th and Hurricane Sandy. One is a man-made disaster; the other, a natural disaster.

They are both in the past. Nonetheless, they both made us feel more vulnerable.

We cannot save the precious lives that were lost. Let’s act now to prepare for the next disaster: Let’s do what we can to regain our sense of control.

Does this idea appeal appeal to you? If not, do you have a better one? There is space below to comment, question, or share.

Halloween and Preparedness Education

Emergency Food Supply, Halloween, Hurricane Sandy, Personal Preparedness

For many people, emergency preparedness arouses ANXIETY.  As a result, they avoid taking simple steps to protect themselves.  They don’t act on the intelligence they have.  They don’t stock up on food and water.

Yet, according to the experts, we might be on our own for 72 hours following a disaster.  [An organization called 72hours.org  offers information in English, Spanish, Russian, and Vietnamese].  The recommendation to have food and water on hand sounds like a no brainer.

I keep asking myself one question: How can emergency preparedness become part of the American way of life?

Shortly after Hurricane Sandy, millions of homes were without electricity. Nonetheless, many children celebrated Halloween.

This year, when children come trick or treating, why not give them two bags of candy? At the same time, recite the following rhyme:

“It’s Halloween, my dear.
It’s time for trick or treat.
Here’s something for the pantry.
Here’s something else to eat.”

It’s one way to educate children about personal preparedness. Do you or your neighbor have a better idea?

Let’s get a conversation going. There’s space below to leave a comment.

Needed: Education About Evacuation

American Red Cross, Disaster Preparedness, Education, Evacuation, Hurricane Sandy, Natural Disaster, Personal Preparedness, ,

When disaster strikes, folks have a choice:  They can “shelter in place” or they can evacuate. Sheltering in place means staying at home or staying at work.

“Home is where the heart is”.  It’s also where our stuff is! Therefore, most people choose to “shelter in place” during a disaster.

Evacuating means leaving home or work and going elsewhere. Leaving familiar surroundings is scary. As a result, many people avoid thinking about it altogether.

This is true for people who live alone. It is also true for families, for people with elderly parents, and for people with pets.

Hopefully, talking about evacuation will reduce its scariness. Then, maybe we can take baby steps toward preparing for it.

There is at least one thing experts agree on: It is the importance of packing a go bag or emergency kit. Packing a go bag should be done ahead of time–that is, before disaster strikes.

How many of us have followed this advice? I do not know.

With Hurricane Sandy, we had advance warning. In some areas, evacuation was mandatory.

In other areas, we had to decide on our own whether to shelter in place or evacuate. We could leave before the storm. If we waited, we knew that our options after the storm might be limited.

Is evacuation necessary? If so, a community-based shelter is probably the option of last resort. Nonetheless, it may be the only option that comes to mind due to television and other media coverage.

What else do people do? Some fly as far away as possible. Some stay with family. Some stay with friends or neighbors. Some–in places like Manhattan–stay at a nearby hotel.

The choices people make when they evacuate depend on many factors. Relevant factors include where their homes are, where they work, when they decide to leave, their support network, and their financial situation.

Each option has advantages and disadvantages.  It makes sense to consider your options now, when things are calm and you can think clearly.

It is important to realize the following:

  • In an emergency, you can find nearby open shelters online.
  • Some shelters take people with special needs and some take pets.
  • A public shelter may be open only temporarily.
  • If your home becomes inaccessible or unliveable,  you might need long-term housing.

Have you worked in an emergency shelter? Have you stayed in one? Have you sheltered with family or friends? Stayed at a hotel? Gone on vacation? Whatever your experience with evacuation, do you have advice for the rest of us?

If so, please comment, question, or share. There is room below.

Resources for Clinicians (Part 1)

Assessment and Treatment for PTSD, , , ,

It’s June.  Another school year is over. The kids are at camp, in the park, or at a pool.  The Fourth of July is less than a week away. It’s vacation time.

June is also PTSD Awareness Month.  Until I began this blog, I had never heard of PTSD Awareness Month.

I have often been struck by the alternate reality that we–as clinicians–have chosen.  I am reminded of the need to balance (try to balance) patient care with self care.  Yes, it’s easier said than done!

The diagnosis of post-traumatic stress disorder (PTSD) first appeared in DSM-III (1980). DSM-5 was published in May, 2013.

Allen Frances, M.D., Chair of the DSM-IV edition, suggested using the document (e.g., DSM-IV) “cautiously, if at all”. I do not recall where I found this quote, but I liked it!

Diagnosis is a useful tool: However, people are complex. They are more than their diagnosis.

DSM-5 recognizes that preschoolers are not simply little people. It has a new diagnosis for children ages 6 and under.

The National Center for PTSD has information about how DSM-5 handles the diagnosis of post-traumatic stress disorder. Check out DSM-5 Criteria for PTSD in “adults, adolescents, and children older than 6 years”. Also check out PTSD for children 6 years and younger.

According to the International Society for Traumatic Stress Studies (ISTSS), the Clinician-Administered PTSD Scale (CAPS) is the “gold standard” for PTSD assessment worldwide. It is available in several languages (e.g., Bosnian).

Fortunately, another version of this instrument, the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) is also available. It is designed for children, ages eight and up, and adolescents.

ISTSS mentions other assessments as well. Some are clinician-administered; some are self-report. Some are for adults; some are for children. Consistent with ISTSS’ international mission, some assessments besides the CAPS are in languages other than English.

The National Center for PTSD, by the way, is part of the United States Department of Veteran Affairs. During the past 30 years, a ton of work has been done on understanding and treating trauma. Much of this work has been a response to the problems of military men and women and their families.

People can, of course, be traumatized more than once. For example, someone who witnesses the death of a friend in Afghanistan can return home and have his/her house flooded.

A complete assessment will, therefore, ask about traumatic events throughout a person’s life. The inquiry may be part of the clinical interview. It may be part of the standardized measures used.

Have you done trauma-focused assessments? If so, have they been in private practice, in a clinic, or in a hospital?

What instruments did you administer? How useful were they? Would they be appropriate (as is or with modifications) for assessing those affected by Hurricane Sandy and other natural disasters?

Is this information helpful?  If so, check out “Resources For Clinicians (Part 2)”.

There is room to Leave A Reply below. Please share what you know.

Local Residents Step Up

When a tornado hit their hometown of Monson, Massachusetts, Caitria and Morgan O’Neill jumped into action.  They were inspired to “leverage technology for a faster recovery”.

Caitria and Morgan O’Neill gave a TED Talk.  Their video is a gem.  It takes less than 10 minutes to watch.

Recovering from a major disaster such as Hurricane Sandy is a long-term process.   Did you know that “50% of web searches happen in the first 7 days” after a disaster? Until I watched the video, neither did I.

What does this statistic mean? It means that local residents are unlikely to benefit from the concern of outsiders over what may be months or even years of recovery.

Major organizations like the American Red Cross arrive right during and right after a disaster.  Then they leave.  It is up to smaller organizations to carry on.   These smaller organizations–many of them religious–often struggle due to inadequate funding.

Did you know that the work done by local volunteers has a dollar value?  Until I watched the video, neither did I.

The dollar value of volunteer time  can help a town get money from FEMA and State governments? However, it needs to be documented.

There is always room for better thinking and new learning.  Please leave a question or a comment.

A Crisco Candle

Blackout, Hurricane Sandy, Personal Preparedness

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“It is better to light a candle than curse the darkness”.  After 9/11, many people left lit candles at memorials around Manhattan. This simple act communicated hope in a time of shock, grief, and sadness.

After Hurricane Sandy, many of us again lit candles.  This time, it was a practical way to avoid sitting in the dark, walking in the dark, and falling down the stairs.

Do you know that you can use a can of Crisco as a makeshift candle? A rolled up piece of paper or some string can serve as a wick.

I did not expect to find Crisco at the local supermarket. However, it was there, in the baking goods aisle.

Don’t be discouraged with your first attempt. Because Crisco is soft, the wick goes in easily. However, you may need to light the wick several times before it catches fire and CONTINUES to burn.

The good news? According to the experts, these Crisco candles will burn for a very long time.

Let’s face it. Preparedness is a complex topic. Some people have an advantage when it comes to emergency preparedness. People who spend time camping, people in the military, and other people with special training have the necessary knowledge as well as hands-on experience.

However, for many other people, living without basic services is a new and frightening idea. One of my favorite sayings is this: “A journey of a thousand miles begins with a single step.” Don’t let fear keep you from taking that all important single step into the unknown.

Do you have a quick and simple idea for emergency preparedness? If so, please share it in the Comments section.

Is Your Household Ready? (A Quick Poll)

Emotional Resilience, Hurricane Sandy, Personal Preparedness
Easy-to-read. Readily available.
Easy-to-read.  Readily available.

There are many types of natural disasters (e.g., hurricanes, tornadoes, and earthquakes). Sometimes, as with Hurricane Sandy, we have advance warning. In other words, we have time for last minute preparations.

Sometimes, we do not. On a beautiful sunny day in June, 2010, a mini-tornado hit the North Shore of Long Island. It appeared out of nowhere. It lasted for about 20 minutes.

During that brief time, it knocked down trees. It stopped electricity. It damaged property. No lives were lost. Nonetheless, it was scary.

The Mailman School of Public Health at Columbia University has an article entitled “The 5 Action Steps to Personal Preparedness“. It states: “Government officials tell us ‘Plan to be on your own for 72 hours'”.

Hopefully, the next emergency will be nothing like Hurricane Sandy. Nonetheless, it makes sense to prepare yourself, your family, and your pets for whatever comes. Better save than sorry!

Some things do not consciously bother us. They are tucked away in the back of our minds. Nonetheless, they feed our overall level of anxiety.

Lack of personal preparedness is that kind of thing. There is an overlooked benefit to planning ahead: We become less anxious.

Let’s agree: Personal preparedness is a responsible and grown up kind of thing. It may be somewhat boring, but it is, nonetheless, a responsible and grown up kind of thing 🙂

I can’t help but wonder: How many of us are prepared? How many of us are well prepared?

Here is an eight-item poll. It’s quick and easy. Check off just the items that apply. Then press “Vote”.

What’s Missing In This Picture?

Emotional Resilience, Hurricane Sandy, Personal Preparedness

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We all know what “hunger” means. Do we all know what “personal preparedness” means?

Personal preparedness means having what you need in an emergency. The emergency could be a hurricane or a major snow storm.

Ideally, we do not want to be fighting for the last can of tuna fish or the last flashlight at the supermarket. We want to have this stuff at home AHEAD OF TIME.

What’s missing in the picture above? Actually, two very important things are missing.

One is a manual can opener. The other is water.

If there is no electricity during an emergency, we can still eat the cereal, the raisins, and the almonds. However, if there is no electricity, an electric can opener won’t work. The result? We will not be able to eat the can of tuna or the can of tomatoes.

The National Center for Disaster Preparedness has a wonderful article. It is entitled “The 5 Steps to Personal Preparedness” (Check it out!)

According to this article, “You MUST have 1 gallon of safe drinking water per person, per day, including pets. Without water a person will die in just a few days, children and pets sooner”.

Words are good. Ideas are grand. However, to be ready for the next Sandy, we need to DO something NOW.

Unfortunately, many things get in the way of doing what we know we should. One of these things is ANXIETY–not just ordinary anxiety, but PRIMITIVE ANXIETY.

It’s an approach-avoidance situation. Taking steps toward preparedness can–in the short run–increase anxiety. To reduce anxiety, we put off doing (and even thinking about) what we know we should do.

Anxiety makes it hard to move ahead. However, if we find a way to outsmart our anxiety, being better prepared–in the long run–reduces anxiety.

What have you done to prepare in the event of another disaster? Does anxiety get in the way of doing what you know you should? If so, what would help you over the hump?

There is a Comments section below. I hope to hear from you.

Ten Tips For Emotional Resilience

Disaster Preparedness, Emotional Resilience, Hurricane Sandy, PTSD

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It seven months later: I’m still thinking about Hurricane Sandy.  As a psychologist, my focus is on the storm’s emotional aftermath.

The people affected are a large group, quite possibly all of us. How will they/we recover from the feelings of helplessness and vulnerability caused by the storm? The answer has much to do with our innate capacity for emotional resilience.

Some people will take advantage of traditional psychotherapy/counseling. Others will use a do-it-yourself (DIY) approach.

It doesn’t matter which group you are in. Here are 10 tips for handling your emotional response(s) to Hurricane Sandy.

1. MINIMIZE EXPOSURE TO THE MEDIA. It’s good to stay informed. Whether it’s coverage of Hurricane Sandy or more recent tragedies, watching stories of misery for hours on end doesn’t help the people affected or you. Will you write to elected officials? Send a check to a charity? Donate clothes? Decide what you will do to aid the recovery. Then stop obsessing and get back to real life.

2. ACCEPT YOUR FEELINGS. Talk about what happened with family, friends, and other people.

3. DON’T SELF-MEDICATE. Avoid alcohol, sleeping pills, and other drugs—either to help you sleep or to deal with feelings. If you are addicted to alcohol or drugs, get involved with a 12-Step Program. If you’re already clean and sober, go to extra meetings to avoid a relapse.

4. MAKE RELAXATION A PRIORITY: Walk the dog, exercise, go to the park, play bridge, ice skate, or do yoga. Now is the time for self-care.

5. RE-ESTABLISH NORMAL ROUTINES. If major losses make “normal” impossible, define a new normal. Then take small steps toward achieving it. Go fishing. Go for a swim. See the fireworks.

6. DON’T ISOLATE. Sometimes, staying inside your own head is not a good place to hang out! Say “thank you” to people who are making a difference. Ask other people how they’re doing. LISTEN to their response.

7. EDUCATE YOURSELF ABOUT PREPAREDNESS. Learn what to do if another storm strikes. The Complete Idiot’s Guide to Disaster Preparedness (2009) is by Maurice A. Ramirez and John Hedtke; it is easy to understand and readily available. To avoid getting overwhelmed, find one thing you can do now to be safer during the next storm. Then do it–even if it’s just buying a fresh supply of batteries!

8. MOURN YOUR LOSSES. Losses can include a beloved pet, a home, a boardwalk, or a favorite tree. Losses can also include your sense of safety and your ability to trust the Long Island Power Authority (LIPA), the Federal Emergency Management Agency (FEMA), and other agencies.

9. RECOGNIZE SYMPTOMS OF POST-TRAUMATIC STRESS DISORDER IN YOURSELF & OTHERS. They include numbing, hyper-arousal, irritability, anxiety, depression, reactivity to reminders of the trauma (seeing fallen trees or living through another storm), tension, stress related medical problems, feelings of detachment and estrangement from others, bad dreams, and insomnia.

10. IF NEEDED, SEEK PROFESSIONAL HELP. Find a licensed therapist familiar with post-traumatic stress disorder (PTSD). Do you have a problem with alcoholism or drug addiction? If so, look for a licensed therapist who is also a Certified Alcoholism and Substance Abuse Counselor (CASAC).

Do these tips ring true? If not, speak up. Comment about what you’ve tried, what’s been helpful, and what’s been a waste of time.

We each have our own story. We need to learn from one another.