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Crisis Counseling Programs for the Rural Community

Coordinating Crisis Counseling Services in the Rural Community

Working With Existing Resources

The organizational structures of rural crisis counseling projects are as varied as the States and communities affected. Flexibility and creativity are highly valued components of a rural crisis counseling project. In a rural area, where there are fewer organized and structured resources, the program must adapt, invent, and convert itself fully to utilize existing resources and to fulfill the mission of the program. How the goals are accomplished and how those outcomes are achieved differ for each program.

Networking gives crisis counseling workers ready access to staff of other programs. Referrals can be made and a good working relationship can develop as a result. Endorsement of the outreach effort also increases the level of investment leaders have in the project. That investment will often carry over to a higher regard for other mental health programs. The following are examples of how rural programs can work with existing resources.

Crisis Counseling Training for Gatekeepers

Mental health needs in a rural community are addressed by more than just local mental health professionals. Clergy, school counselors, physicians, health care workers, welfare workers, funeral directors, and many other gatekeepers are a vital part of the rural community's support system. Some of these individuals, by virtue of their role in the community, may have awareness of people who have not yet come into contact with the crisis counseling project. Apprising these people of crisis counseling services and offering training on disaster mental health, basic crisis intervention, and counseling skills is prudent. Because the gatekeepers may come into contact with disaster survivors who need more intensive mental health services, the training needs to include procedures for referrals.

Consultation

Some people may be actively involved in providing support and care to others who simply need to discuss the disaster's impact with someone trained in disaster mental health. Outreach workers can provide valuable consultation to these people in helping them understand the normal, expected responses to the disaster. Agencies and institutions may also need consultation to help them assist their staff and clients. Existing social and human service agencies, as well as groups that were formed as part of the disaster recovery effort, are examples of agencies that may benefit from consultation. Outreach efforts for formal agencies are similar to those provided to the natural network of gatekeepers. Provide information on what is normal and predictable, as well as when and where to seek help and from whom.

Community Organization

The important role the community plays in the daily life of the rural disaster survivor makes it essential for outreach workers to participate in committees and other community structures as part of the disaster response and recovery effort. This participation gives continuous opportunity for the workers to keep other key people and programs updated on the crisis counseling services. Also, serving on committees provides opportunity for the workers to know the status of other relief efforts, how to access the various resources, and where there may be pockets of unreached individuals. The restoration of natural networks and support systems must be addressed on a community-wide basis. Information and handouts on disaster recovery phases and disaster mental health response issues can greatly enhance planning efforts.

Referral Options

Some individuals will experience significant emotional distress, even at the time the program is closing. These people may need a referral for traditional mental health care. This can be a sensitive issue in rural communities and should be addressed in crisis counseling training during the preparation for program closure. The rural attitudes and unique characteristics of the service area will affect how people respond to a mental health referral. Often, options for making an effective mental health referral may be limited. In particular, inpatient care may be difficult to access. Specialized care for children, substance abuse problems, and many other issues requiring unique treatment programs may be located more than 100 miles away.

Being well acquainted with the intake and/or treatment staff of the local community mental health provider(s) is important for the crisis counseling staff. In addition, the mental health provider should know and have a working relationship with other programs whose services may be helpful to disaster survivors.

Networking with Community Resources

To be effective, rural crisis counseling projects must establish themselves in the mix of programs and organizations active in the disaster response (See Appendix C for a listing of organizations and resources involved in disaster response and recovery). Identifying what other resources and services are available is essential to providing good information to recipients of outreach. Providing information to other programs and services about the crisis counseling project extends the efforts of outreach staff and results in referrals. Interagency meetings provide information on the current status of services, changes in programs, and referral criteria. These meetings may also provide an opportunity to problem-solve where difficulties may have developed in working relationships.

Shared Meal

It is important to understand that in rural areas, a shared meal can be a powerful conduit to interaction and problem-solving among disaster survivors, community leaders, and crisis counselors. Although Federal regulations and FEMA policy do not allow crisis counseling funds to be spent on entertainment, rural crisis counseling projects have successfully brought survivors and community resources together for meetings with food served using the following strategies:

• Encourage potluck meals held at a neutral community site such as a community center, school, or church. Such meals can precede/follow support group meetings or community forums featuring such speakers as FEMA, unmet needs committee representatives, local, State, or Federal government representatives, or outreach workers. Such potluck events can be creatively organized around themes such as desserts only, with donations to cover coffee.
  
  
• Organize donated meals provided by community groups or local service organizations for the same purposes as listed above. Such organizations may actually cook meals (chili supper, pancake breakfast) on-site for the meeting participants. One Midwestern community held monthly support group meetings at local restaurants. The restaurant meeting site changed monthly. Each month a different service group paid for the meals. It was also a boon for the local business owners who hosted these groups at their dining establishment.
  
  
• Dutch treat meals can be successful if the price is reasonable. Groups can either meet at a local restaurant or have a local caterer provide the food. Keeping costs low is best. Do not rule out breakfast meetings if that is a good time for survivors to participate. Remember that lunch is usually less expensive than an evening meal.
  
  

Offering coffee and cookies or some type of shared meal can facilitate disaster survivor interaction and participation in community forums, support groups, etc., in rural communities. Local programs can be as creative as possible to provide food for these meetings while adhering to FEMA crisis counseling regulations.

Religious Groups and Clergy

The ability to provide information regarding disaster crisis counseling services to a wide cross-section of the community is enhanced greatly by working with and through the various churches and religious organizations in a community. Working as an ally with church groups can open the way for outreach to many families. Religious groups can mobilize many people and are fertile soil for finding volunteers. The benevolent work of such groups can provide an effective alternative to the outreach worker becoming over involved in the issues of shelter, clothing, and financial resources. Religious organizations such as interfaith groups and ministerial alliances can ensure a coordinated and comprehensive effort within the religious community.

One by-product of involvement with church groups is the ability to reach several age groups in one setting. There also may be church groups for specific ages. In addition, each person in the groups has his or her own network of family, friends, and co-workers who might also benefit from crisis counseling services.

In areas where cultural and ethnic populations reside, the church may be the one source of contact trusted by the community as a whole. The lack of trust or confidence a person has for local, State, or Federal government can create a barrier to receiving much needed assistance. The barrier can often be overcome by involving a church or other community organization the disaster survivor trusts.

Pastors, rabbis, and clergy may need crisis counseling themselves. Religious leaders are often stretched to the limit with their congregation's post-disaster needs. An added stressor may be the financial health of the parish due to reduced income of members. Provide clergy members information on key concepts of disaster mental health, stress management, and anniversary reactions. This information can be used for sermons, as inserts in the church program or bulletin and posted on parish bulletin boards.

Community Groups

Crisis counseling projects should work with community groups by providing information on common disaster mental health reactions, the services available through the crisis counseling project, and how to obtain additional information. The following list of community groups in a rural area can assist in identifying people needing crisis counseling:

• Local American Red Cross
• Salvation Army
• City or Regional Development Corporations
• Agricultural Soil Conservation Service (ASCS)
• Veterinarians
• City and County Government
• Mail carriers
• Funeral directors
• Cooperative Extension Offices
• Farm Organizations such as National Farmers Organization (NFO), Farm Bureau, Farmer's Aid and Farm Resource Center
• Churches
• Ministerial Alliance
• Native American Groups
• Migrant Worker Services
• Local Immigrant Groups and Organizations
• Clubs such as: Lions, Rotary, Kiwanis, Civitan, Ruritan, Elks, Eagles, and Oddfellows
• Business and Professional Women (BPW)
• Women's Sororities
• Chambers of Commerce
• Child Welfare Agencies
• Pre-schools, Day Care Centers, Head Start Programs, and Birth to Three Programs
• Schools, Public and Private including Junior Colleges, Colleges and Universities
• Hospitals
• Senior and low income housing
• Rural Health Clinics
• Substance Abuse Treatment Facilities
• Alcohol and Drug Prevention Education Programs
• Physicians, Dentists, Chiropractors
• Home Health Agencies
• Visiting Nurse Association (VNA)
• Pharmacists
• Seniors programs
• Seed corn dealers
• Farm implement dealers
• Battery and tire businesses
• Insurance offices
• Banks and other lending businesses
• Employment Security Office
• Public Assistance Office
• Public Health Department
• Vocational Rehabilitation
• Developmental Disabilities Services
• Nursing homes and sheltered care facilities
• Barbers and beauticians
• Restaurants and coffee shops
• Home delivery sales people
• Utility meter readers
• Catholic Social Services
• Lutheran Social Services

The list could go on and on. In each rural community there are unique groups and organizations that can assist in identifying disaster survivors in need of crisis counseling services.

Special Community Services

Community Healing Events

In a rural community, the recovery of individual disaster survivors is greatly impacted by the community's ability to heal. Around the one year anniversary of the disaster, residents may plan a variety of community events to commemorate the disaster. Often such events commemorate the casualties of disaster, celebrate the recovery, and show appreciation for those who helped others. A single event may be able to reach a whole rural community or several smaller events may be organized. When the timing is right and there is broad community interest, involvement, and support, community events can be a powerful force in bringing closure coupled with positive anticipation for the future. Commonly, these events will express "how far we have come" since the disaster's onset. The event is an opportunity to bring together the rural community that may have been dispersed due to housing shortages and changes in employment.

Crisis counseling workers must remember that while most of the community may be ready and interested in a "healing event," not everyone will share this desire. Some people may not feel like celebrating or coming together. These people may experience a heightened sense of isolation from their neighbors and friends due to this difference. They may fear that something is wrong with them since everyone else seems ready to get on with their lives. Sensitivity to these different feelings is an important way the crisis counseling project can ensure that it is responsive to everyone, no matter where they are in the recovery process (CMHS, 1994).

Prior to the anniversary date, there may be symbolic and ceremonial expressions of grief and support. These may be organized, but more often occur spontaneously. They may be more isolated expressions of individuals or small groups and not the wider community. There is a healing impact in such expressions that may pave the way for the healing of the community as a whole. Being sensitive to the use of terminology is also important. A "commemoration" may be considered more appropriate than a "celebration."

Crisis counselors can provide helpful consultation to community groups considering such events, and can be useful in helping to coordinate and implement them. Running the show is seldom useful for the crisis counseling project unless requested by the community.

Continued Access to Needed Services

At program close it is important that clear communication take place with other community programs working cooperatively with the crisis counseling effort. These community programs can be of valuable assistance in identifying other support services and individuals that can serve as resources. Many people in rural communities do not know what services are available or from whom. Crisis counseling staff can inform local programs of what type and degree of continued mental health support will be available to the community through the local mental health provider. All recipients of the crisis counseling services need to be notified that they will be referred to local/regional resources if there is continuing need.

Flyers or brochures outlining existing resources for various types of human service needs should be prepared. Public education can be provided to civic groups and businesses. Public service announcements about the closing of the project can get the word out and be used for expressions of thanks to the various people and organizations in the community who have supported the program. Disseminating information regarding human service assistance programs is always important.

Recognition and Appreciation

During the closing weeks, program coordinators and administrators should express appreciation and provide recognition to those people in the community who assisted the crisis counseling project. Letters of thanks not only to the people themselves, but to the supervisor or the director of their organization, can communicate such appreciation. Recognition at a public meeting with appreciation letters or certificates can be effective.

A by-product of this effort is continued good working relationships beyond the disaster. Most of the organizations and people who have provided crisis counseling services during the months of the program will continue to work and live in the same communities. The cooperative spirit and mutual appreciation that existed during the disaster recovery effort carries over in many cases to the ongoing working relationships.

There are many examples of interagency groups that began to meet because of disaster and continued well after other recovery efforts were done. They continued in this fashion, not out of reluctance to let go of the disaster, but because they found the networking and information sharing at such meetings to be essential to their more routine working relationships.

Chapter 4 | Table of Contents