(Adapted from the Crisis Management Handbook: A Guide for Overseas Staff, Peace Corps Volunteer Safety Council)

4. AFTER THE CRISIS: RETURNING TO NORMAL

Regardless of the nature and extent of a crisis, it usually has an impact on everyone. The students and staff in the country are profoundly affected by every tragedy and unforeseen crisis that occurs to one of their numbers. The host country nationals and counterparts who work with the students and staff are just as deeply touched by events and will require emotional support and stress relief. The administration and staff of the college or university/study abroad program, students, and family members and friends are all part of the larger community affected by a crisis. All these connections will need continued attention as you return to normal after the crisis. The timely support to students and staff in the immediate aftermath of a crisis is critical.

4.1 DEBRIEFING

Some form of debriefing is absolutely necessary for the students and staff after relief from duty or at the conclusion of the crisis event. Critical Incident Stress Debriefing (CISD) is an organized approach to managing stress response in those who have experienced a crisis situation. It is used with individuals or groups and consists of three basic components:

• Helping crisis survivors vent feelings and assess the intensity of the stress response;
• Instruction, support and reassurance by the facilitator and/or other survivors; and
• Mobilization of resources and return to normal roles with a plan for further assistance if needed.

There are four types of CISD. Each has its own application but the common goal is to provide support and minimize the development of abnormal stress in emergency or crisis survivors.

4.1.1 The On-Scene or Near-Scene Demobilization is the briefest form of CISD. It is a continuous process conducted during the crisis as shifts change or natural breaks in the action occur. An observer (mental health professional, chaplain, other support personnel) functions as an advisor at the scene of the action and during brief rest periods. The observer should not be involved directly in managing the crisis but is there primarily to support staff and students. The observer also assesses and reports any signs of severe stress and recommends appropriate action.

The demobilization process aims to:

• Mitigate the immediate impact of the event
• Accelerate the recovery process
• Assess the need for debriefing and other support
• Reduce cognitive, emotional, and physiological symptoms

4.1.2 The Initial Defusing is the group process (30-45 minutes) provided immediately after a traumatic event, once the individuals are disengaged from the on-scene operations.

• process of the defusing aims to:
• Establish non-threatening social environment
• Allow rapid ventilation of stressful experience
• Equalize access to facts and information
• Restore cognitive processing of event
• Provide information for stress survival
• Affirm value of individuals
• Establish linkages for additional support
• Develop expectancies for the future

The defusing components are as follows:

1. Introduction

• Introduce facilitator(s)
• State Purpose
• Invite voluntary participation
• Establish ground rules (not therapy, not investigation)
• When possible assure confidentiality (no notes, recording, etc.)
• Describe process
• Offer additional support

2. Exploration

• Ask individuals to describe what just occurred
• Answer questions of clarification
• Review experiences and reactions
• Assess need for more help
• Reassure participants, as necessary

3. Information

• Accept/summarize their exploration
• Normalize experiences and reactions
• Teach multiple stress survival skills
• Advise diet & nutrition, alcohol/caffeine avoidance
• Pay attention to rest & relationships
• Recommend recreation & exercise

4. Aftermath

• Offer handshake and comment to each participant
• Provide one-on-one follow-up
• Determine whether to proceed with debriefing

The defusing process may provide the necessary support to groups or individuals, however it may happen that the defusing will reveal that need for further support. Indicators that additional support may be necessary include:

• Intense emotions, unusual behavior
• Unfinished business
• A sense (sometimes subtle) of incompleteness
• Excessive silence

4.1.3 The Formal CISD is a guided discussion (2-3 hrs.) of traumatic event occurring 48-72 hrs after the event that aims to:

Prevent stress dysfunction

• Screen and prioritize individual needs
• Identify areas for follow-up support and referrals

The CSID process is delineated into seven distinct stages. It is important to follow all the stages in order to realize optimal effectiveness. The CISD moves the participants form the cognitive level (less threatening to express) through the emotional level (essential to explore and address) and back to the cognitive level (where the participants find comfort). A skilled facilitator or mental health professional is necessary because of the intensity of the emotional content that is often elicited. The seven stages of the CISD process are as follows:

Before debriefing it is important for the intervention team to:

• Review case documents, incident reports, press clippings, etc
• Circulate among the group in order to establish informal contacts, study relationships and individual behaviors, and gather additional background information
• Hold strategy meeting to agree on focus, roles and responsibilities.

After debriefing it is important for the intervention team to:

• Make one-on-one contact with all participants, inviting those deemed needful of further individual support to attend follow-up session.
• Conduct post-debriefing review with team:
  - "How did we do?"
  - "What did we learn?"
  - Coordinate any follow-up
  - Check-in with each team member, "Are you okay?"
• If necessary, write post-action report keeping it general, ensuring confidentiality, and focusing on lessons learned.

The issues likely to emerge for students and staff in the aftermath of an evacuation or program suspension are:

• Coping with the loss of personal belongings;
• Lack of opportunity to say good-bye to friends;
• Inability to bring closure to projects/ coursework;
• Dealing with the sudden need to plan next steps;
• Dealing with previous experience of loss and disappointment that the situation may evoke;
• Loss of control of daily activities and immediate future;
• Abandoning previous goals and aspirations;
• Concerns about status, earning academic credit, refunds, etc.
• Feelings of powerlessness, being manipulated.

The following actions have proven useful to Peace Corps Volunteers who have survived a crisis or had to terminate service prematurely. It may be useful for study abroad students forced to leave a program early.

• Share the experience and feelings generated by the crisis to help with the healing process and prevent delayed stress symptoms. The sharing has proven most effective when it takes place shortly after the event.
• Focus on the time spent in country and what was learned and experienced.
• Realize that even if they are fortunate enough to return to the country, much may have changed. Social relations and the way host country nationals in general view them may change as a result of the crisis, especially those political in nature. Students should be prepared for the differences they may encounter upon return.
• Acknowledge that the recovery process is hard and takes time. Everyone will progress at his/her own pace.
• Take time out before making new commitments.
• Turn to family and friends for support over the long haul.

4.1.4 The Follow-up CISD is often not necessary but can occur several weeks or months after the event to help with closure and re-entry. This process focuses on achieving closure, attending to unfinished business and looking ahead to a return to "normality" for students and staff.

4.2 RETURNING TO NORMAL

Once a crisis event (evacuation, program suspension) has passed, the decision whether to return to the site may arise. Despite the appearance that a critical situation has returned to normal, the crisis may have precipitated many changes, including:

• How host country nationals view United States or individual staff or students;
• The social relations among local individuals, agencies, groups;
• The level of functioning of essential services (water, electricity, public transport, etc.);
• The relative security of once-safe regions of the country;
• The sensitiveness and reactions of individuals or groups to questions or innovations; or
• The viability and/or appropriateness of established programs.

A re-assessment of the post environment and general conditions should be undertaken by the post management team. A determination of the current site can be made through general observations and discussion with the on-site administrator(s), local officials, and other study abroad programs in the area. The decision to return or not to return and the reasoning that supports that decision should be made clear to students and staff, with ample opportunity to discuss concerns and possible consequences.

While getting back to everyday routine tasks is an important step in the return to "normality", one should expect and prepare for symptomatic reactions to the post-crisis reality. Some reactions to watch for are:

• Depression
• Anxiety
• Emotional letdown
• Lassitude
• Task dysfunction

A re-entry program that provides a supportive forum for staff and students shortly after a return to site should provide a forum to discuss and resolve program and adjustment issues.

(Adapted from the Crisis Management Handbook: A Guide for Overseas Staff, Peace Corps Volunteer Safety Council)