Supporting Materials (Tips) for Using the Fact Sheet

Appendix C: Guidance Materials for Staff Using the ATSDR Stress Fact Sheet 07/28/2017

Appendix C.1

Tips on using the “Coping with Stress” fact sheet for

Share and discuss the Coping with Stress fact sheet with individuals or small groups of community members who express interest in the topic.

ATSDR & Health Department staff

Keep in mind

• The intent of the fact sheet is to validate stress as a normal reaction to environmental contamination, suggest ways to cope with that stress, and point people to resources if stress is affecting their daily life.

• Communicate with empathy: put yourself in the shoes of the people you are working with.

How to use the fact sheet

Use it responsively

• Bring it with you whenever you are in a community: “keep it in your back pocket”

• Share it with individuals when they mention they are feeling stress

• Balance the stress fact sheet information with information on the site-specific health/exposure issue

Use it passively

• Put it out on a table along with other fact sheets at an Open House or community meeting about the site – and talk with people about it if they express interest

Talking with a community member, leader, or health provider

Responding

• If someone tells you they are stressed, ask if any of the issues on p. 1 are causing them stress

• If yes, ask if they have thought about ways to cope with stress and point them to the section “ways to cope” (see p. 2 of fact sheet, left side)

• If a person says that stress is negatively affecting their daily life, suggest resources for help (p. 3, right side, and local resources)

Initiating

• If you suspect that stress may be an issue for someone, and feel comfortable gently introducing the topic, then

  • State it is normal for people affected by environmental contamination to experience some stress.

• Note that ATSDR has developed a fact sheet on this topic and ask if they are interested in looking at it with you.

• If you have a good relationship with a trusted leader and/or health provider in a community you think might be experiencing stress, consider sharing the fact sheet with them and asking if they think the information would be helpful to community members.

  • Encourage the leader or health provider to share the fact sheet with community members who may be interested in the topic. Follow up in a month to see if they've used it.

Pitfalls

• Don’t compare potential stress-related health effects with physical health effects related to exposure (e.g. “The stress you are feeling may be worse for your health than the exposures from the site.”)

• Don’t attempt to

  • determine whether someone is showing signs of stress (box on p. 2 of fact sheet)

  • diagnose or treat mental health conditions

• Don’t force the conversation. Community members might not want to talk about stress and that’s OK.

• Be careful when discussing personal behaviors. The statement “Take care of yourself” (pg. 2, left side) may provoke some people if you talk about changing behaviors like smoking, drinking alcohol, diet, and exercise in a way that is perceived as “blaming the victim.”

• Don’t overpromise – ATSDR does not have the capacity to develop stress-specific community interventions at this time.

Don’t use the stress fact sheet…

• …In a large group setting when it is difficult to judge how people are reacting to the information (e.g. community presentation, conference call)

• …To respond to concerns about possible physical health effects of exposures to site-related contaminants

• …When someone wants answers to other questions

• …When someone is expressing outrage or anger

Make your own site-specific stress fact sheet

• Use this fact sheet as a template and source of general information

• Modify the reasons for stress to reflect concerns you’ve heard from the community (p. 1)

• Modify the “Ways to cope” section (p. 2, left side)

  • To include information on advisory groups (e.g. CAPs or CAGs) or other ways to get involved

  • Include references (e.g. web addresses, repository) where people can get information about possible physical health concerns of site-related contaminants (e.g. ToxFAQs, site-related fact sheets)

• Modify the “Get in touch” section to include locally available mental health resources that would resonate with the community (p. 2, right side).

Fill out the feedback form each time you use the fact sheet

• After you use the stress fact sheet with community members, please fill out the feedback form.

• Your responses will help ATSDR improve the stress materials and help staff use them more effectively in communities.

Who to talk to at ATSDR about using the fact sheet

• Ben Gerhardstein, Environmental Health Scientist, ATSDR Region 9 (415.947.4316, bgerhardstein@cdc.gov)

• Jamie Rayman, Health Educator, ATSDR Region 9 (415.947.4318, jrayman@cdc.gov)

• Pam Tucker, MD, ATSDR/DTHHS (770.488.3458, pgt0@cdc.gov)

Appendix C.2

Additional reading about stress

Use the resources below to learn about stress and community-wide stress interventions before using the ATSDR Stress Fact Sheet in a community setting

Learn about stress and how it can affect people’s health

• There are different types of stress

  • The different kinds of stress: http://www.apa.org/helpcenter/stress-kinds.aspx

  • Understanding chronic stress: http://www.apa.org/helpcenter/understanding-chronic-stress.aspx

  • Stress: https://medlineplus.gov/stress.html

• Stress can have various health effects

  • Stress effects on the body http://www.apa.org/helpcenter/stress-body.aspx

  • How stress affects your health: http://www.apa.org/helpcenter/stress.aspx

  • Video: How stress affects your brain: http://ed.ted.com/lessons/how-stress-affects-your-brain-madhumita-murgia

• There are warning signs of stress

  • Listening to the warning signs of stress: http://www.apa.org/helpcenter/stress-signs.aspx

• People can use stress management techniques to cope with or reduce stress

  • Manage stress: https://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/heart-health/manage-stress#the-basics_1

Be aware of community-wide stress intervention resources

• The ATSDR stress fact sheet may be helpful for individual community members, but some communities may be interested in broader public health strategies for reducing stress.

• Evidence-based strategies for community-wide stress interventions are grounded in community disaster relief principles and community resilience theory.

  • Principles of disaster relief: Disaster Theory – An Interdisciplinary Approach to Concepts and Causes. (Book by David Etkin).

  • Community resilience: Community resilience as a metaphor, theory, set of capacities and strategy for disaster readiness. https://www.ncbi.nlm.nih.gov/pubmed/18157631

• These reports provide a starting place for staff interested in learning about community-wide stress interventions related to environmental contamination. Such events are often called “Slow-Motion Technological Disasters” or “Chronic Technological Disasters” in the literature.

  • Community-Level Social Support Responses in a Slow-Motion Technological Disaster: The Case of Libby, Montana https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779910/

  • Public health strategies identified during ATSDR’s 1995 Expert Panel on Psychological Responses to Hazardous Substances: https://www.atsdr.cdc.gov/risk/prhs/panel3_results.html

• Dr. Pam Tucker (DTHHS) is available to discuss strategies ATSDR has used in the past to address community-wide stress (770.488.3458, pgt0@cdc.gov).

  • Slides from Dr. Tucker’s June 2017 Topic in Environmental Health Exposure Investigation presentation, “Understanding and Responding to Community Stress: A Guide for Environmental Health Workers” are available on the DCHI SharePoint site, or upon request.

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