Trauma-Informed Response

Mental and emotional health are greatly impacted by disasters and other emergencies. However, because it is not considered an “essential” need, specific teams that provide support for mental and emotional health may not be available for quite some time after an emergency occurs. We can, however, approach everyone we interact with after an emergency in a supportive and trauma-informed way.

Empathetic listening is key to connecting with people impacted by an emergency and being able to help them effectively.

Empathetic Listening: Don’t / Do

DON’T	DO
Ask questions that only result in “yes” or “no” answers.	Use open-ended questions. Example: “Can you tell me more about your current situation?”
Judge or shame their actions, experiences, or preferences.	Express acceptance for their situation, and our shared humanity. Examples: “That sounds hard.” / “Do you want to tell me more about that?”
Offer forceful instruction, tell them what they “must” do, or give them a plan without collaborating with them.	Offer accurate information and suggestions, help them think through challenges, and help them make a plan. Examples: “Do any of those options sound good to you?” / “What challenges do you see?”
Use behavior-change communication, coerce, or shame.	Offer support in a variety of ways: connect to extra food resources (or formula if formula-dependent), connection with other mothers/families, connection with a lactation support provider, etc. Also see above.
Get frustrated if the person you are trying to help is quiet, unable to make a decision, or avoids or delays responding to certain questions.	Remember that trauma shows up in many ways. Try giving extra time to respond, asking if they want you to come back, asking if they want more information, or offering two options. Examples: “Would you like a suggestion?” / “Does ____ or ____ sound like it might help?”
Be critical of, express discomfort with, or leave because someone expresses emotion.	Some options: smile, say it’s okay to express how they feel, offer a tissue if convenient, ask if they want a hug or other support.

Caring for Ourselves as Responders

Disasters and emergencies of all kinds impact everyone who deals with them, including — and sometimes especially — responders, aid workers, and other volunteers. Caring for our physical and mental health is essential to being able to continue helping.

Basic Self-Care Reduces or Prevents Problems

These suggestions may sound basic and not worth mentioning, but in disaster work there is always more to do than can be done, and taking breaks can be challenging for many of us, especially in the field. It is important for your entire team to continually remind one another of the need to care for their own needs, even giving “permission” or support when necessary.

Meeting Physical Needs	Meeting Emotional Needs
Rest regularly	Take breaks
Stay hydrated	Do fun things sometimes
Exercise, stretch, move	Journal
Eat healthy food, including vegetables	Meditate
Take a multivitamin if practical	Talk with others
Mask, gloves, and other PPE when indicated	Share losses and celebrate wins together

Raw or Resilient?

Recognizing when we are stressed, triggered, or no longer in an emotionally resilient state helps us know when we need to take more time to care for our own needs. Here are some ways we can recognize which state we are in.

When stressed or traumatized, we may…	When emotionally resilient, we will…
Unknowingly hold tension in our bodies.	Be aware of tension and try to relax.
Ignore signs of hunger, thirst, pain.	Be aware of our body’s signals.
Have difficulty making decisions.	Know what we need in order to make decisions.
Tend to be in arguments/disagreements.	Be able to negotiate challenging events.
Feel inhibited by fear or anxiety.	Be courageous.
Get irritated at differences.	Understand different perspectives.
Not know how we feel emotionally.	Sense when emotions need processing.
Have trouble falling asleep.	Be able to settle ourselves to sleep.
Snap at people, or get angry easily.	Know when we are losing our cool and need a break.
Be unable to feel gratitude.	Often be able to find gratitude in hardship.
Feel hopeless or depressed.	Be hopeful; see a path to improvement.
Feel incompetent or unhelpful.	Feel competent to create change.

As Responders, What Helps Us Regain Equilibrium?

Regaining equilibrium when we are already in a survival state (sympathetic dominance, a.k.a. fight or flight) is different from relaxing when we are feeling a little stressed but feel secure and safe overall. For many people, some of the same techniques that help when feeling a little stressed will have no impact — or may sometimes make one feel worse — when in a survival state.

Techniques & Practices to Reduce the Impact of Traumatic Events

Do at least one each day, more as needed.

• Sighing and deep breathing, preferably with movement or sound
• Vagus nerve stimulation — sing, hum, gargle
• Bilateral stimulation (e.g., EMDR, tapping)
• Shake it out; dancing
• Express emotions — stomp, yell, hit pillows, etc.
• TRE (Tension Release Exercises)
• Talk with others
• Body movement
• Play music / listen to music
• Spend time with family and friends
• Nap
• Avoid caffeine, tobacco, and alcohol, especially in large amounts

Additional Resources

L.I.F.E. Basic Kit A list of mental health resources is available in the L.I.F.E. Support Basic Kit from the Carolina Global Breastfeeding Institute: https://sph.unc.edu/cgbi/cgbi-resources-l-i-f-e-support-basic-kit/

SAMHSA Disaster Response Mobile App Offers first responders immediate access to support for any type of traumatic event at every phase of response, including pre-deployment preparation, on-the-ground assistance, and post-deployment resources.

• Apple: https://apps.apple.com/us/app/samhsa-disaster-response-app/id787518271
• Google Play: https://play.google.com/store/apps/details?id=gov.hhs.samhsa.app.disaster

Trauma-Informed Resources from SAMHSA https://www.samhsa.gov/mental-health/trauma-violence/trauma-informed-approaches-programs

SAMHSA publication library search for trauma- and disaster-related publications: https://library.samhsa.gov/

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Questions

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