Substance Abuse & Mental Health Services Administration

Materials for Self-Care and Stress Management | General Disaster Response | Deployment Guidance
Leaders and Supervisors | Substance Use after a Disaster
Disaster Behavioral Health Interventions | Psychological First Aid (PFA)

Materials for Self-Care and Stress Management

General Disaster Response

American Psychological Association. (2011, August). Managing traumatic stress: Tips for recovering from disasters and other traumatic events. Retrieved from http://www.apa.org/helpcenter/recovering-disasters.aspx 

This tip sheet discusses normal reactions to a disaster or traumatic event and the steps that can be taken to alleviate stress.

Headington Institute. (n.d.). Self-study: Understanding and addressing vicarious trauma. Retrieved from http://www.headington-institute.org/default.aspx?tabid=2648 

According to this web page, "vicarious trauma can be thought of as the negative changes that happen to humanitarian workers over time as they witness other people’s suffering and need." This fact sheet discusses the signs and symptoms of vicarious trauma and suggests what disaster responders should do if faced with vicarious trauma.

National Fallen Firefighters Foundation. (2006). Firefighters’ mental health. Retrieved
from http://media.cygnus.com/files/cygnus/article/FHC/2006/APR/dm0602_10500421.pdf [PDF - 50.6 KB] 

This drill complies with and supports the Safety Initiatives of the National Fallen Firefighters Foundation. The objective of the drill is identified as follows: "The firefighter will demonstrate a general knowledge of the mental health issues affecting the fire service, indicators of potential concerns, and corrective action options."

National Fallen Firefighters Foundation. (2011, July 11–12). Issues of depression and suicide in the fire service: Meeting report. July 11–12, 2011; Baltimore Maryland. Retrieved from http://lifesafetyinitiatives.com/13/depressionsuicide_summary.pdf [PDF - 1.61 MB] 

This report summarizes and includes links to a white paper on depression and suicide in the fire service. It focuses on depression, suicide prevention and intervention, and recommendations for the field.

Stamm, B. H. (2009). Professional quality of life: Compassion satisfaction and fatigue   
version 5 (ProQOL). Retrieved from
http://www.proqol.org/uploads/ProQOL_5_English_Self-Score_3-2012.pdf [PDF - 106.4 KB] 

The ProQOL is the most commonly used measure of the negative and positive effects of helping others who experience suffering and trauma. The ProQOL has sub-scales for compassion satisfaction, burnout, and compassion fatigue.

Suicide Prevention Resource Center. (2005, May 24). First responders: Emergency medical technicians and firefighters. Retrieved from http://cretscmhd.psych.ucla.edu/nola/video/Clergy/Articles/The%20Role%20of%20First%20Responders%20in%20Preventing%20Suicide.pdf [PDF - 90.9 KB] 

This fact sheet provides resources and tips for disaster responders including information on the role of disaster responders in preventing suicide, ways in which disaster responders can help suicide attempters and survivors, and ways for disaster responders to help themselves and their fellow responders.

Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (n.d.). Information for relief workers on emotional reactions to human bodies in mass death. Retrieved from http://www.cstsonline.org/wp-content/resources/CSTS_body_recovery_relief_workers.pdf [PDF – 64.6 KB] 

This fact sheet provides lessons learned by relief workers who have worked with the bodies of the deceased in disaster environments. It aims to help lessen the psychological effects of body recovery and allow workers to live with their experiences and memories without being haunted by them.

U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC). (2002). Traumatic incident stress: Information for emergency response workers. Retrieved from http://www.cdc.gov/niosh/docs/2002-107/pdfs/2002-107.pdf [PDF - 423 KB]

This fact sheet outlines symptoms of traumatic incident stress and what emergency response workers can do on site and at home to cope with disaster response.

HHS, CDC. (2008). Stress management for emergency responders: What responders can do [Audio podcast]. Retrieved from http://www2c.cdc.gov/podcasts/player.asp?f=10613

According to its online description, "this is the third in a series of five podcasts on stress management for individuals, teams, and agencies working in emergency and humanitarian aid settings. These podcasts examine sources of stress at each level and what individuals, team leaders, and agency management can do to manage the stress. It gives practical guidance on ways to reduce stress and lessen its negative impacts on staff and the mission."

HHS, CDC. (n.d.). Disaster mental health primer: Key principles, issues and questions. Retrieved from http://www.bt.cdc.gov/mentalhealth/primer.asp

This fact sheet presents the "impact pyramid," which includes disaster responders among those affected by a disaster. It discusses common disaster reactions, the phases of disaster, potential risk groups, and signs that someone might need help.

HHS, CDC. (n.d.) Health recommendations for relief workers responding to disasters.
Retrieved from http://wwwnc.cdc.gov/travel/content/relief-workers.aspx

This web page provides advice specific to the needs of relief workers responding to disasters internationally or domestically related primarily to healthcare risks and recommendations. It includes a health-related preparedness checklist.

HHS, CDC, Agency for Toxic Substances and Disease Registry. (2009). Surviving field stress for first responders [Online course]. Available from http://www.atsdr.cdc.gov/emes/health_professionals/surviving_field_stress.html

According to its main web page, this online course is "designed to help first responders and those they assist to be prepared for the stressors of 21st century disasters. . . . The target audience for this course is first responders, fire paramedics, police and healthcare providers as well as Federal, State, and local public health and emergency management officials who may respond to disaster events."

HHS, CDC, National Institute for Occupational Safety and Health (NIOSH). (2010). Traumatic incident stress: Information for emergency response workers. Retrieved from http://www.cdc.gov/niosh/topics/traumaticincident

This online fact sheet highlights the physical, cognitive, emotional, and behavioral symptoms that disaster responders may experience after a disaster. It includes tips and resources to assist responders in taking care of their own emotional health.

HHS, Substance Abuse and Mental Health Services Administration (SAMHSA). (2007). A guide to managing stress in crisis response professions (HHS Publication No. SMA 4113). Retrieved from http://store.samhsa.gov/shin/content//SMA05-4113/SMA05-4113.pdf [PDF - 1.3 MB]

This is a pocket guide that provides first responders with information on signs and symptoms of stress and offers simple, practical techniques for minimizing stress responses prior to and during disaster response.

HHS, SAMHSA. (2007). Tips for survivors of a traumatic event: Managing your stress  
(HHS Publication No. NMH05-0209R). Retrieved from http://store.samhsa.gov/shin/content//NMH05-0209R/NMH05-0209R.pdf [PDF – 927 KB]

This tip sheet outlines the common signs of stress after a disaster and provides stress reduction strategies.

HHS, SAMHSA. (2012). Self-care for disaster behavioral health responders [Podcast]. Retrieved from http://www.samhsa.gov/dtac/selfcareDBHResponders/lib/playback.asp

The goal of this 60-minute podcast is to provide information, best practices, and tools that enable disaster behavioral health responders and supervisors to identify and effectively manage stress and secondary traumatic stress through workplace structures and self-care practices.

U.S. Department of Labor, Occupational Safety and Health Administration. (n.d.). Let us take care of YOU! Health, safety, and resilience for disaster responders. Retrieved from http://www.osha.gov/SLTC/emergencypreparedness/resilience_resources/support_documents/predeploy/cdc_pamphlet.html

This tip sheet provides physical and psychological safety tips for disaster responders.

U.S. Department of Veterans Affairs, National Center for PTSD. (2007). Working with trauma survivors: What workers need to know. Retrieved from http://www.samhsa.gov/dtac/FederalResource/Response/21-Working_with_Trauma_Survivors.pdf [PDF - 43.2 KB]

This tip sheet discusses the importance of understanding different types of traumatic stress and the risk of burnout when working with trauma survivors.

University of Medicine and Dentistry of New Jersey, New Jersey Center for Public
Health Preparedness. (2005, September 1). First responders: Self care, wellness, health, resilience, and recovery dealing with stress [PowerPoint presentation]. Retrieved from http://www.njcphp.org/legacy/drup/index.php?q=node/115 

This presentation covers how disaster responders can deal with the stress they may experience while helping their communities respond to and recover from a disaster, how they can prepare for the pressures they may face, and how they can help their families.

The University of North Carolina Center for Public Health Preparedness. (n.d.). Self-care for disaster responders. Retrieved from http://cphp.sph.unc.edu/training/HEP_DRN6/certificate.php 

This presentation is designed to build awareness of the importance of self-care and identifies basic self-care principles for a disaster responder.

Young, B. H., Ford, J. D., & Watson, P. J. (2007, January 1). Disaster rescue and response workers. Retrieved from http://www.ptsd.va.gov/professional/pages/disaster-rescue-response.asp

This fact sheet explains the different stressors that affect disaster response workers and provides tips on how to cope with stress during, after, and upon returning home from a disaster.

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Deployment Guidance

Uniformed Services University of the Health Sciences. (2004, summer). Becoming a couple again: How to create a shared sense of purpose after deployment. Retrieved from http://fhp.osd.mil/pdhrainfo/media/Courage_to_Care.pdf [PDF - 666 KB]

This tip sheet contains information for a family reuniting after a member returns home from deployment.

HHS, SAMHSA. (2005). Returning home after disaster relief work: A post-
deployment guide for emergency and disaster response workers (HHS Publication No. NMH05-0219). Retrieved from http://store.samhsa.gov/shin/content/NMH05-0219/NMH05-0219.pdf [PDF - 4.53 MB]

This guide is intended to assist deployed employees when they are transitioning back into their regular work situations following deployment.

HHS, SAMHSA. (2005). Returning home after disaster relief work: A post-
deployment guide for families of emergency and disaster response workers (HHS Publication No. NMH05-0220). Retrieved from http://store.samhsa.gov/shin/content//NMH05-0220/NMH05-0220.pdf [PDF - 4.6 MB]

This guide is intended to assist families reunite when a member returns from emergency response or disaster response duties. It offers advice on adjustment to home life, basic post-deployment needs, possible redeployment, signs of stress, and when to seek help.

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Leaders and Supervisors

Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (2005). Leadership stress management. Retrieved from http://www.cstsonline.org/wp-content/resources/CSTS_leadership_stress_management.pdf [PDF - 69.1 KB] 

This fact sheet discusses tips for leaders to monitor and minimize their stress when managing teams during traumatic events.

Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (2006). Natural disasters: Optimizing officer and team performance. Retrieved from http://www.cstsonline.org/wp-content/resources/CSTS_law_enforcement_natural_disasters.pdf [PDF - 97.9 KB] 

This tip sheet is intended to help managers and supervisors limit officer stress resulting from disaster response.

Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (n.d.). Stress management for health care providers. Retrieved from  http://www.deep.med.miami.edu/media/StrssMngHthCrProvidUSUHS.pdf [PDF - 79.4 KB] 

This fact sheet offers a management plan that leaders and supervisors can implement to help minimize psychological challenges for healthcare provider staff working closely with trauma victims.

HHS, SAMHSA. (2005). Returning home after disaster relief work: A post-deployment guide for supervisors of deployed personnel (HHS Publication No. NMH05-0218). Retrieved from http://store.samhsa.gov/shin/content/NMH05-0218/NMH05-0218.pdf [PDF - 3.1 MB]  

This guide is intended to assist supervisors in easing transition, reducing potential difficulties, and enhancing positive consequences for disaster response workers. It provides self-care tips and coping strategies and describes common issues that may arise.

HHS, SAMHSA. (2007). Tips for managing and preventing stress: A guide for
emergency response and public safety workers (HHS Publication No. KEN-01-0098R2). Retrieved from http://store.samhsa.gov/shin/content/KEN01-0098R2/KEN01-0098R2.pdf [PDF - 1.7 MB]

This fact sheet presents organizational and individual stress prevention and management approaches for disaster response workers.

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Substance Use after a Disaster

Clark, H. W. (n.d.). Traumatic events and substance use: Demands on the
substance abuse treatment delivery system. Retrieved from http://www.samhsa.gov/csatdisasterrecovery/featuredReports/traumaticEventsAndSaDemandsOnSaTreatment.pdf [PDF - 688.5 KB]

This presentation, developed by the Director of the Center for Substance Abuse Treatment, discusses substance abuse treatment after disasters and trauma using data collected after Hurricane Hugo, the Oklahoma City Bombing, and the terrorist attacks of September 11, 2001.

Ewing, J. A. (1984). Detecting alcoholism: The CAGE Questionnaire. Journal of the American Medical Association, 252(14), 1905–1907. Retrieved from http://jama.jamanetwork.com/data/Journals/JAMA/4438/JAMAclassics110508.pdf [PDF - 2.6 MB] 

The CAGE questionnaire is an easy-to-remember screening tool for detecting alcoholism. Public safety workers can use this tool to determine if they, a coworker, or even someone they assist in the field is in need of treatment.

National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. (n.d.). Screening Tests. Retrieved from http://pubs.niaaa.nih.gov/publications/arh28-2/78-79.htm

This web page provides information on the Alcohol Use Disorders Identification Test (AUDIT), CAGE, and T-ACE screening tests. AUDIT and CAGE can be used in a variety of settings and with a range of target populations. T-ACE is a test developed to ascertain drinking in pregnant women.

New York City Department of Health and Mental Hygiene. (2006, August). Clinical guidelines for adults exposed to the World Trade Center disaster. City Health Information, 25(7), 47–58. Retrieved from http://www.nyc.gov/html/doh/downloads/pdf/chi/chi25-7.pdf [PDF - 554.7 KB]

This clinical guide describes how providers can learn to identify, evaluate, treat, and refer patients with physical and mental health conditions that could be associated with exposure to the September 11, 2001 disaster. It explains that physical, mental health, and substance abuse conditions are often intertwined and outlines a coordinated approach to behavioral health care. Recommended screening and treatment tools are also included.

HHS, SAMHSA. (n.d.). Alcohol and drug use screening, intervention, and referral: Changing the Nation's approach to comprehensive healthcare [Webcast]. Retrieved from http://store.samhsa.gov/product/Alcohol-and-Drug-Use-Screening-Intervention-and-Referral-Changing-the-Nation-s-Approach-to-Comprehensive-Healthcare/DVD183

This webcast discusses how healthcare providers can use screening, brief intervention, and referrals to help people with substance abuse problems get treatment.

HHS, SAMHSA. (n.d.). Tips for first responders: Possible alcohol and substance abuse
indicators. Retrieved from http://store.samhsa.gov/shin/content//NMH05-0212/NMH05-0212.pdf [PDF - 185.7 KB]

This tip sheet describes indicators or warning signs disaster responders should look for that are often associated with alcohol and drug addiction. These tips will be useful for public safety workers in determining if disaster survivors are in need of referral to behavioral health assistance.

U.S. Department of Veterans Affairs, National Center for PTSD. (2007, January 31). Disasters and substance abuse or dependence. Retrieved from http://www.ptsd.va.gov/professional/pages/disasters-substance-abuse.asp

This tip sheet summarizes empirical research on substance abuse or dependence following a disaster.

University of Miami, Center for Disaster and Extreme Event Preparedness. (n.d.). Handout: Alcohol, medication, and drug use after disaster. Retrieved from http://www.samhsa.gov/csatdisasterrecovery/outreach/05-SA_Disasters_Handout.pdf [PDF - 65.1 KB]

This tip sheet provides recommendations for ways to manage alcohol, medication, and drug use following a disaster. It also provides suggestions for those who have had a past alcohol, medication, or drug problem.

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Disaster Behavioral Health Interventions

Association of Professional Chaplains. (2006). Guidelines for coping with disaster and mass casualty. Retrieved from http://www.professionalchaplains.org/uploadedFiles/pdf/Guidelines%20for%20Coping%20with%20Disaster%20and%20Mass%20Casualty.pdf [PDF - 66.0 KB] 

This tip sheet offers guidelines to disaster responders who are working with faith-based organizations.

Phillips, S. B., & Kane, D. (n.d.). Guidelines for working with first responders (firefighters, police, emergency medical service and military) in the aftermath of disaster. Retrieved from http://www.agpa.org/events/clinician/Guidelines%20for%20Working%20with%20First%20Responders%20in%20the%20Aftermath%20of%20Disaster.html 

This online tip sheet lists common characteristics of disaster responders, suggests interventions for working with disaster responders, and provides additional resources in working with this population.

Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (2005). Guidelines on notifying families of dead or missing loved ones. Retrieved from http://www.cstsonline.org/wp-content/resources/CSTS_guidelines_missing_death_notification.pdf [PDF - 56.5 KB] 

This fact sheet provides guidance for disaster responders assisting in the recovery efforts for events with large numbers of dead, injured, and missing persons. It offers dos and don'ts for notifying families of dead or missing loved ones.

HHS, CDC. (2005, August 30). Disaster mental health for responders: Key principles, issues and questions. Retrieved from http://www.bt.cdc.gov/mentalhealth/pdf/responders.pdf [PDF – 188 KB]

This fact sheet highlights mental health-related information that can be beneficial for a disaster responder in recovery efforts after a disaster.

HHS, SAMHSA. (2002). Communicating in a crisis: Risk communication guidelines for
public officials (HHS Publication No. SMA 02-3641). Retrieved from http://www.hhs.gov/od/documents/RiskCommunication.pdf [PDF – 454 KB]

This is a pocket guide for public officials that provides the basic components of effective communication during a crisis.

HHS, SAMHSA, Center for Mental Health Services. (2000). Field manual for mental health and human service workers in major disasters (HHS Publication No. ADM 90-0537). Retrieved from http://disaster.efpa.eu/download/db9803ae8b738aa208a1082292b1968e [PDF - 142.6 KB] 

This field manual is for mental health workers and other human service providers who assist survivors following a disaster. A pocket reference, it provides the basics of disaster mental health, with numerous specific and practical suggestions for workers. Hardcopies of this manual can be ordered at http://store.samhsa.gov/product/ADM90-0537.

HHS, SAMHSA, Center for Mental Health Services. (2000). Training manual for mental health and human service workers in major disasters (second ed.) (HHS Publication No. ADM 90-0538).Retrieved from http://www.samhsa.gov/dtac/FederalResource/Response/4-Training_Manual_MH_Workers.pdf [PDF - 400 KB]

This training manual provides an overview of information essential to mental health and human service workers in times of disaster, including how disasters affect children, adults, and older adults; the importance of tailoring the program to fit the community; descriptions of effective disaster mental health interventions; and strategies for preventing and managing worker stress.

U.S. Department of Veterans Affairs, National Center for PTSD. (2007, January 1). Treatment of PTSD. Retrieved from http://www.ptsd.va.gov/public/pages/treatment-ptsd.asp

This online fact sheet discusses some treatments shown to be effective for posttraumatic stress disorder (PTSD), as well as treatment for PTSD when coupled with another disorder. It also offers information for new clients on what to expect from a therapist.

U.S. Department of Veterans Affairs, National Center for PTSD. (2007, July 5). Early mental health interventions for disasters. Retrieved from http://www.ptsd.va.gov/professional/pages/early-intervention-disasters.asp

This online fact sheet contains information on initial mental health interventions that are in line with the basic principles of emergency care. This document also provides an overview of PFA.

U.S. Department of Veterans Affairs, National Center for PTSD. (2010). Psychosocial treatment of disaster related mental health problems. Retrieved from http://www.ptsd.va.gov/professional/pages/handouts-pdf/Psychosocial_Treatment.pdf [PDF - 69.1 KB]

This tip sheet offers information for practitioners immediately after a major disaster. It provides recommended interventions for individuals experiencing normal and severe stress reactions.

Young, B. H., Ford, J. D., & Watson, P. J. (2007, January 1). Helping survivors in the wake of disaster. Retrieved from http://www.ptsd.va.gov/professional/pages/helping-survivors-after-disaster.asp

This web page offers information on normal reactions to disasters, more severe reactions, and the goals for first responders in a disaster.

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Psychological First Aid (PFA)

National Child Traumatic Stress Network (NCTSN). (n.d.) Psychological First Aid
online. Retrieved from http://learn.nctsn.org/course/category.php?id=11 

PFA Online features an "interactive course that puts the participant in the role of a provider in a post-disaster scene. . . . It features innovative activities, video demonstrations, and mentor tips from the Nation's trauma experts and survivors."

NCTSN, & National Center for PTSD. (2006). Psychological First Aid field operations guide (second ed.). Retrieved from
http://www.nctsnet.org/nccts/nav.do?pid=typ_terr_resources_pfa 

This guide provides the details of PFA, which is, according to this website, "an evidence-informed approach for assisting children, adolescents, adults, and families in the aftermath of disaster and terrorism."

New York City Department of Health and Mental Hygiene, Office of Mental Health
Disaster Preparedness and Response. (2005). Providing Psychological First Aid (PFA). Retrieved from http://www.nyc.gov/html/doh/downloads/pdf/mhdpr/mhdpr-pfa.pdf [PDF - 40.4 KB]

This tip sheet offers quick reference to the principles of PFA and offers self-care tips for disaster responders.

Siarnicki, R. J. (2010, December 7). Understanding Psychological First Aid for first responders [Web log message]. Retrieved from http://my.firefighternation.com/profiles/blogs/understanding-psychological?q=profiles/blogs/understanding-psychological 

This article provides an overview of basic PFA principles and how they relate to firefighters and emergency medical technicians.

Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (2005). Psychological First Aid: Helping victims in the immediate aftermath of disaster. Retrieved from http://www.deep.med.miami.edu/media/P1stAidHlpVictImAftrUSUHS.pdf [PDF - 1.7 MB] 

This tip sheet was designed for disaster responders working in international emergency situations. It outlines guidelines for proper use of PFA.

Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (n.d.). Psychological First Aid: How you can support well-being in disaster victims. Retrieved from http://www.cstsonline.org/wp-content/resources/CSTS_psychological_first_aid.pdf [PDF - 76.0 KB] 

According to this fact sheet, it offers tips on providing PFA to disaster survivors in distress to "help alleviate painful emotions and reduce further harm from initial reactions to disasters."

HHS, SAMHSA. (2005). Psychological First Aid for first responders: Tips for emergency and disaster response workers (HHS Publication No. NMH05-0210). Retrieved from http://store.samhsa.gov/shin/content//NMH05-0210/NMH05-0210.pdf [PDF - 400.9 KB]

This pamphlet provides a brief explanation of PFA for first responders and information for working in the field.

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