Article

Psychosocial interventions in the early phases of disasters

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Abstract

Interest in the emerging field of disaster psychology has significantly increased after such events as the Oklahoma City bombing and the September 11th (2001) terrorist attacks. Consequently, a massive response has ensued from clinicians seeking to provide mental health services to disaster victims, highlighting the need to ensure timely and clinically effective service provision. The present article is directed toward clinicians and trainees interested in learning more about the disaster mental health field. It describes the impact of disasters on communities and individuals and the most commonly employed interventions. The authors emphasize the distinction between the fields of disaster psychology and traumatology and stress that expertise in treating trauma-related disorders is not sufficient preparation for conducting psychosocial disaster intervention. Finally, information is provided on how to obtain adequate training and experience as a disaster mental health professional.

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... Although certain commonalities exist, each disaster event differs with regard to setting, scope, duration, and populations affected. Domestically, the Federal Emergency Management Agency (FEMA) estimates that on average, 4000 national disasters -56 of which are presidentially-declared national disasters -have occurred each year over the past decade (FEMA, 2010a; Reyes & Elhai, 2004). These disasters have ranged from transportation disasters to acts of terrorism. ...
... Accordingly, there have been calls for the DoD to develop more extensive, evidence-based training programs for military care providers responding to disaster (Amundson et al., 2008;Mancuso et al., 2008). Outside of the military, the field of disaster mental health (DMH) suffers from a similar lack of coordination and consensus regarding training requirements and best practices (Reyes & Elhai, 2004;Wickramage, 2006;Young, Ruzek, Wong, Salzer, & Naturale, 2006). ...
... Key competencies include the ability to coordinate care, work effectively with people of different backgrounds and cultures, and manage personal reactions. Given the heterogeneous nature of disasters, care providers must be proficient in quickly assessing situations and evaluating current needs and resources, even in disorganized settings with limited infrastructure (Reyes & Elhai, 2004, Young et al., 2006. Knowledge of trauma and posttraumatic stress can be helpful for conceptualizing reactions to disaster and informing interventions. ...
... Purpose Demobilization was designed to allow First Responders to "ventilate" their feelings or verbally process stress reactions (Reyes & Elhai, 2004) about a critical incident on a one-on-one or group basis (Mitchell & Bray, 1990). ...
... Mitchell and Bray (1990) do not explicitly describe when "ventilation" occurs during the 30-minute timeline; however, the authors underscore the importance of ventilation. Ventilation has been defined as verbally processing stress reactions within a group context (Reyes & Elhai, 2004). The theory has been that sharing experiences about an event can demonstrate the need for additional services, which can then be detected by supervisory staff and appropriately addressed. ...
... The intent has been to facilitate closure and the transition back to home life (Armstrong, O'Callahan, & Marmar, 1991). The MSD program has also been called the American Red Cross (ARC) debriefing approach (Reyes & Elhai, 2004) and the American Red Cross (ARC) Disaster Mental Health Service (DMHS; Weaver, Dingman, & Morgan, 2000). The available literature remains unclear as to whether MSD can or should be offered as a stand-alone intervention or as part of a broader CISM program. ...
... Disaster mental health interventions include formal psychiatric treatment for psychiatric disorders and an array of wellness-and resilience-basedpsychosocialinterventionsforemotionaldistressandsocialproblems (Table 2 and Figure). 26, [63][64][65][66][67][68][69][70][71][72][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92] The most effective interventions are those chosen appropriately for the type of need determined in the clinical assessment. Although most people affected by disasters do not develop psychiatric disorders, almost everyone with exposure to severe disaster trauma will experience distress for at least a brief period. ...
... 16 Thus, early interventions are indicated for the majority of survivors to reduce distress, provide emotional support, educate, and normalize emotional responses, even before new psychiatric disorders have time to develop and be diagnosable. 20,34,88 Among the most commonly described interventions in the disaster mental health lit- "Psychological first aid" is a popular term used to describe a set of practical early interventions and principles administered by clinicians or nonclinicians to address emotional distress. 88 Psychological first aid is akin to physical first aid, with parallel goals: to stabilize psychologicalandbehavioralfunctioningbymeetingbasicphysicalneedsandthen addressing psychological needs; to mitigate psychological distress and dysfunction; to facilitate return to adaptive psychological and behavioral functioning; and to promote access to further care. ...
... 20,34,88 Among the most commonly described interventions in the disaster mental health lit- "Psychological first aid" is a popular term used to describe a set of practical early interventions and principles administered by clinicians or nonclinicians to address emotional distress. 88 Psychological first aid is akin to physical first aid, with parallel goals: to stabilize psychologicalandbehavioralfunctioningbymeetingbasicphysicalneedsandthen addressing psychological needs; to mitigate psychological distress and dysfunction; to facilitate return to adaptive psychological and behavioral functioning; and to promote access to further care. 93 Psychological first aid should be embedded in public health, mental health, medical, and emergency response systems. ...
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Exposure to a disaster is common, and one-third or more of individuals severely exposed may develop posttraumatic stress disorder or other disorders. A systematic approach to the delivery of timely and appropriate disaster mental health services may facilitate their integration into the emergency medical response. To review and summarize the evidence for how best to identify individuals in need of disaster mental health services and triage them to appropriate care. Search of the peer-reviewed English-language literature on disaster mental health response in PsycINFO, PubMed, Cochrane Database of Systematic Reviews, Academic Search Complete, and Google Scholar (inception to September 2012) and PILOTS (inception to February 2013), using a combination of subject headings and text words (Disasters, Natural Disasters, Mental Health, Mental Health Programs, Public Health Services, Mental Disorders, Mental Health Services, Community Mental Health Services, Emergency Services Psychiatric, Emotional Trauma, Triage, and Response). Unlike physical injuries, adverse mental health outcomes of disasters may not be apparent, and therefore a systematic approach to case identification and triage to appropriate interventions is required. Symptomatic individuals in postdisaster settings may experience new-onset disaster-related psychiatric disorders, exacerbations of preexisting psychopathology, and/or psychological distress. Descriptive disaster mental health studies have found that many (11%-38%) distressed individuals presenting for evaluation at shelters and family assistance centers have stress-related and adjustment disorders; bereavement, major depression, and substance use disorders were also observed, and up to 40% of distressed individuals had preexisting disorders. Individuals with more intense reactions to disaster stress were more likely to accept referral to mental health services than those with less intense reactions. Evidence-based treatments are available for patients with active psychiatric disorders, but psychosocial interventions such as psychological first aid, psychological debriefing, crisis counseling, and psychoeducation for individuals with distress have not been sufficiently evaluated to establish their benefit or harm in disaster settings. In postdisaster settings, a systematic framework of case identification, triage, and mental health interventions should be integrated into emergency medicine and trauma care responses.
... The main idea is that people without extensive medical knowledge or training can be taught to provide immediate help without further injuring a person. 32,33 As with crisis intervention, the key ingredients of PFA are empathy and compassion, and the imperatives are to reduce the risk of harm, stabilise psychological distress, and provide practical assistance, such as connecting the person with other resources. 33,34 Supportive psychotherapy does not aim to change personality traits or defence mechanism, but rather to stabilise them. ...
... 32,33 As with crisis intervention, the key ingredients of PFA are empathy and compassion, and the imperatives are to reduce the risk of harm, stabilise psychological distress, and provide practical assistance, such as connecting the person with other resources. 33,34 Supportive psychotherapy does not aim to change personality traits or defence mechanism, but rather to stabilise them. It has a specific meaning derived from psychoanalysis, which describes the therapist's support for the patient's adaptive or more mature personality defence. ...
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Article
Background: health workers are one of the groups affected physically as well as psychologically from the pandemic. Recent studies showed many of the health workers reported experiencing anxiety, depression, and insomnia. This study aims to identify psychotherapy as a psychological health intervention, for healthcare workers during the COVID-19 pandemic. Methods: an evidence based clinical review of psychotherapy as a psychological health intervention, reported in the literature, which is developed for healthcare workers during the COVID-19 pandemic. The review was conducted following set out for Evidence-based clinical review by searching the following digital libraries: PubMed, ProQuest, Cochrane, and Google Scholar. Results: six publications were selected. The identified psychotherapy used as a mental or psychological intervention for healthcare workers during COVID-19 consists of supportive psychotherapy, psychoeducation, social support, and music therapy. Overall, it shows that psychotherapy, especially supportive psychotherapy, can reduce anxiety, depression, and insomnia. Conclusion: the physiological condition of health workers needs to get attention during the COVID-19 pandemic. Although there is no standard of therapy yet, psychotherapy could be an option as it is proven to be able to reduce anxiety, depression, and insomnia.
... Depression, anxiety, acute stress disorder, substance abuse, and relationship breakdowns that occur in this time are often transitory and will resolve over time. 15,16,20,25,30 Preventative mental health services are aimed towards at-risk populations whose coping capacity may be overwhelmed: those people who have lost loved ones, a home, property, belongings, community or employment. 20 Interventions include providing emotional support, helping survivors understand disaster-related stress and grief reactions, and clarifying their behaviours and reactions are normal and expected given the abnormal situation. ...
... One of the most important roles identified for mental health workers after a disaster is to listen to disaster survivors' stories. By listening to stories, workers can provide reassurance and validate and normalise survivors' emotions and reactions.5,15,[18][19][20]25,26 ...
Article
Mental health workers play an important role in caring for traumatised people after a disaster. While there is much literature about disaster responses, little has been written from the perspective of mental health workers. Aim: The aim of this integrative review is to explore the current evidence related to the personal and professional responses to the impact of a disaster; the roles, actions, involvement, psychological preparation and reactions of mental health workers working in the aftermath of a disaster. Methods: Relevant literature published between 1996 and 2012 was identified through electronic databases. Articles were reviewed if they discussed the roles of mental health workers in communities post disaster. Thirty-one peer reviewed journal articles met the inclusion criteria. Results: Two themes emerged relating to the tasks, roles, skills and actions mental health workers perform during a disaster response, and the emotional impact of the work on the mental health workers. Conclusions: Findings identified a gap in the literature about the education and preparedness of mental health workers to support traumatised survivors immediately after a disaster, and the long-term impact of a disaster on mental health workers who are themselves survivors yet continue to provide care to others in affected communities.
... Since its development as a "group processing technique" for relieving occupational stress in emergency workers, CISD has expanded and evolved (Reyes & Elhai, 2004). It was embraced as a preferred technique for stress management and has been mandated in some police, emergency care, and fire departments in the United States and internationally (Reyes & Elhai, 2004). ...
... Since its development as a "group processing technique" for relieving occupational stress in emergency workers, CISD has expanded and evolved (Reyes & Elhai, 2004). It was embraced as a preferred technique for stress management and has been mandated in some police, emergency care, and fire departments in the United States and internationally (Reyes & Elhai, 2004). Mitchell founded the International Critical Incident Stress Foundation, Inc. (ICISF), which was established to promote CISD and assure a high quality of training. ...
Article
When a person experiences a traumatic event, s/he may have a strong emotional reaction. This reaction may disrupt the person's ability to function at the scene of the incident or later, and may range from a normal stress response to the symptoms indicative of Post Traumatic Stress Disorder (PTSD). Psychological debriefing is an immediate intervention used following a trau-matic experience that purportedly helps individuals manage their normal stress reactions to the incident. Critical Incident Stress Debriefing (CISD) was designed for workers in high-risk occu-pations, such as police officers, disaster workers, and firefighters. Critical Incident Stress Management (CISM) is a multi-compo-nent intervention system that incorporates CISD. The use of this intervention has been expanded to individuals, groups, and com- munities. While this intervention has been used extensively fol-lowing traumatic events, its efficacy is under much debate. Currently, there is a controversy regarding the issue of whether it helps with initial distress and if it does, in fact, prevent post-trau-matic symptoms. This review is limited to studies assessing emergency response workers, as critical incident stress debriefing and management was originally designed for this population.
... 25 Psychological first aid can be administered by nonclinicians to address emotional stress until professional intervention is available. 26 Psychological first aid should be ethnically, culturally, and developmentally appropriate to individual needs, striving to foster resilience and the natural impetus for recovery. ...
... Psychoeducation also entails providing information to parents, teachers, responders, and public officials to encourage empathy, enhance social support, promote help seeking, and decrease the stigma associated with mental health services. 26 Sahin et al. 52 examined the use of psychoeducation for children and parents after an earthquake in Turkey. Although participants had access to information through other channels, the 2 groups perceived the intervention to be beneficial. ...
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Article
This Practice Parameter identifies best approaches to the assessment and management of children and adolescents across all phases of a disaster. Delivered within a disaster system of care, many interventions are appropriate for implementation in the weeks and months after a disaster. These include psychological first aid, family outreach, psychoeducation, social support, screening, and anxiety reduction techniques. The clinician should assess and monitor risk and protective factors across all phases of a disaster. Schools are a natural site for conducting assessments and delivering services to children. Multimodal approaches using social support, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
... That is why it is necessary to start early psycho-social interventions with disaster survivors so that positive coping can be built and strengthened and abnormal reactions to the stressful situation can be reduced, thus leading to the prevention of mental illnesses such as posttraumatic stress disorder (PTSD). [22][23][24] The results of the current study corroborate with various Indian and western studies and with those of Ogueji et al. [25] and Kar et al. [26] who explained in their studies that during any stressful circumstances people adopt positive coping startegies such as seeking social support, being empathetic, getting involved in exercise, indore games, yoga or meditation, mentally preparing for stressors, thinking positively, maintaing healthy eating habits, engaging themselves in games and activities, focusing on self-care, self-motivation and hoping for the best. ...
... However, the literature presents few epidemiological studies on such impacts and even fewer from an economic standpoint. Indeed, the psychosocial impacts of disasters have been described from the standpoint of mental health signs and symptoms (Bolin, 1985;Leon, 2004), of the delay between the stressor and its onset (Adams and Boscarino, 2006) and of the intervention and its importance in the recovery phase (Reyes and Elhai, 2004;Dückers et al., 2017). However, case studies abound for various types of hazards around the world (e.g., forest fires: Kulig and Dabravolskaj, 2020;oil spills: Gill et al., 2016;nuclear accidents: Midorikawa et al., 2017;train derailments: Généreux et al., 2019floods: Johal and Mounsey, 2016). ...
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Article
The assessment of psychosocial impacts related to coastal hazards (erosion, submersion) has so far been mainly qualitative. As cost-benefit analysis is gaining popularity among communities to assess adaptation options in the face of increasing coastal hazards, there is a need to develop quantitative indicators to improve the inclusion of human impacts in decision-making. The project therefore aimed to suggest quantitative indicators for a cost-benefit analysis in the Lower St. Lawrence region exposed to the waters of the estuary of the St. Lawrence River in eastern Quebec, Canada. A systematic survey of five municipalities was conducted in 2019 ( n = 101). In general, the prevalence of mental health impacts was the double than that of physical health (30 vs. 14%); and was higher for affected respondents: 50.0 and 23.9%, against 13.5 and 5.8% for unaffected respondents. With regards to psychosocial impacts, the main results were that affected people were 2.33 more stressed in normal times than unaffected respondents and this variation increased to 3.54 during a storm surge warning; the quality of sleep of affected respondents when a storm warning is issued was 2.39 poorer than that of unaffected respondents. With regards with economic impacts, an additional 11% in absenteeism has been observed among respondents affected; the likelihood of experiencing financial difficulties was 1.27 higher for those affected; a small subgroup of affected respondents (<10) declared a mean of 400 CAD of additional health expenses. The results show that the assistance received provides little protection against stress, or even increases it, if it is mainly financial. In addition, a high degree of social isolation and living alone increases stress in the face of hazards. Thus, social capital and psychosocial assistance act as a protective factor in reducing psychosocial impacts. The probability of financial stress, on the other hand, increases in the event of maladaptation (inefficient adaptation expenditures leading to repair costs). Overall, the importance of the impacts measured justifies further economical investigation for their inclusion in the cost-benefit analysis.
... Without a standardized format for the approach, the majority of the COVID-19 PFA programs were developed by mental health professionals not necessarily trained in disaster response (Herbert et al., 2001). Behavioral health professionals often believe they are already well-versed in disaster psychology by virtue of their professional training alone but this is inaccurate (Everly et al., 2010;Reyes & Elhai, 2004). PFA can and is safely delivered by the trained layperson or healthcare professional, but core elements of PFA are not foundational to healthcare curriculums (Subbarao et al., 2008). ...
Article
Psychological first aid is a form of support designed to lessen disaster‐related distress. In a pandemic, providers may need such support but with the high risk of exposure, such a program is offered only virtually. The research is scant for traditional post‐disaster support and non‐existent for virtual; therefore, by using related research this discussion considers the likelihood of providers accessing and benefiting from this program. The virtual platform is heralded as the responsible way to provide support in a pandemic but this standard may be ineffective and is inherently inequitable. As a global event, pandemics require containment strategies applicable on an international level; therefore, psychosocial support should also be developed with an international audience in mind. Online psychosocial support falls short of being such a strategy as it incorrectly assumes global internet access. Many low‐income areas such as Sub‐Saharan Africa will need support strategies which compliment local frontline staff and fit with community‐driven initiatives, whereas wealthier countries may use a combination of onsite and online support. Provider psychosocial support needs in a pandemic, if articulated, are globally similar but how this support is offered requires contextually sensitive considerations not yet found in the literature.
... These consequences are of sufficient magnitude, requiring immediate efforts and direct interventions to reduce the impact of the outbreaks at both individual and population levels (Galea et al., 2020). Psychoeducation and emotional support in particular help to normalize crisis reaction, mobilize resources, and increase adaptive coping strategies for progression to serious mental illness such as major depression or PTSD (North & Pfefferbaum, 2002;North, Hong, & Pfefferbaum, 2008;Reyes, 2004). However, many countries have tended to focus on the physical health needs of COVID-19, often neglecting mental health needs with few designated organizations offering specific mental health services with easy access to those in need. ...
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Article
The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on infectious disease, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 pandemic, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. Culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.
... These consequences are of sufficient magnitude, requiring immediate efforts and direct interventions to reduce the impact of the outbreaks at both individual and population levels (Galea et al., 2020). Psychoeducation and emotional support in particular help to normalize crisis reaction, mobilize resources, and increase adaptive coping strategies for progression to serious mental illness such as major depression or PTSD (North & Pfefferbaum, 2002;North, Hong, & Pfefferbaum, 2008;Reyes, 2004). However, many countries have tended to focus on the physical health needs of COVID-19, often neglecting mental health needs with few designated organizations offering specific mental health services with easy access to those in need. ...
Article
The upsurge in the number of people affected by the COVID-19 is likely to lead to increased rates of emotional trauma and mental illnesses. This article systematically reviewed the available data on the benefits of interventions to reduce adverse mental health sequelae of infectious disease outbreaks, and to offer guidance for mental health service responses to infectious disease pandemic. PubMed, Web of Science, Embase, PsycINFO, WHO Global Research Database on COVID-19, and the preprint server medRxiv were searched. Of 4278 reports identified, 32 were included in this review. Most articles of psychological interventions were implemented to address the impact of COVID-19 outbreak, followed by Ebola, SARS, and MERS for multiple vulnerable populations. Increasing mental health literacy of the public is vital to prevent the mental health crisis under the COVID-19 pandemic. Group-based cognitive behavioral therapy, psychological first aid, community-based psychosocial arts program, and other culturally adapted interventions were reported as being effective against the mental health impacts of COVID-19, Ebola, and SARS. During the COVID-19 pandemic, culturally-adapted, cost-effective, and accessible strategies integrated into the public health emergency response and established medical systems at the local and national levels are likely to be an effective option to enhance mental health response capacity for the current and for future infectious disease outbreaks. Tele-mental healthcare services were key central components of stepped care for both infectious disease outbreak management and routine support; however, the usefulness and limitations of remote health delivery should also be recognized.
... Psychological first aid (PFA) is a set of early interventions and principles provided by clinicians and nonclinicians for people in emotional distress (Reyes, 2004), especially for those with acute stress from recent trauma (Bisson & Lewis, 2009). The goals of PFA are to stabilize psychological functioning, mitigate psychological distress and dysfunction, facilitate the return to adaptive psychological and behavioral functioning and promote access to further care (Everly & Flynn, 2006). ...
Article
Background The outbreak of coronavirus disease 2019 (COVID-19), like severe acute respiratory syndrome (SARS), provokes fear, anxiety and depression in the public, which further affects mental health issues. Taiwan has used their experience of the SARS epidemic for the management of foreseeable problems in COVID-19 endemic. Aim/Objective This review summarizes issues concerning mental health problems related to infectious diseases from current literatures. Results In suspected cases under quarantine, confirmed cases in isolation and their families, health care professionals, and the general population and related effective strategies to reduce these mental health issues, such as helping to identify stressors and normalizing their impact at all levels of response as well as public information and communication messages by electronic devices. The importance of community resilience was also addressed. Psychological first aid, psychological debriefing, mental health intervention and psychoeducation were also discussed. Issues concerning cultures and religions are also emphasized in the management plans. Conclusion Biological disaster like SARS and COVID-19 not only has strong impact on mental health in those being infected and their family, friends, and coworkers, but also affect wellbeing in general public. There are evidenced that clear and timely psychoeducation, psychological first aid and psychological debriefing could amileorate negative impact of disaster, thus might also be helpful amid COVID-19 pandemic.
... Additionally, they must anticipate that planned interventions may be interrupted by the impact of the ongoing pandemic on their patients' daily lives. As such, the focus of therapy might shift from targeted interventions to supportive care as patients struggle with specific fear, acute stress, grief, community disruption, and financial insecurity (Reyes & Elhai, 2004). Aside from adjusting to a new therapeutic format, trainees have the opportunity to assimilate vast amounts of information and gain a deeper appreciation for the broader socio-political implications that COVID-19 will have on communities, including highlighting preexisting social inequalities that might directly affect their patients. ...
Article
The emergence of the coronavirus disease 2019 (COVID-19) pandemic has wide-ranging implications for the field of professional psychology. As clinical practice has rapidly adapted to ensure continuity of care, doctoral students have encountered unique opportunities for ethics-related competency development across practicum training settings. This article discusses the relevant American Psychological Association (APA) Ethics Code standards and additional ethical considerations facing trainees as they navigate their foundational clinical experiences and develop as professional psychologists in light of a pandemic.
... Afetlerden etkilenen topluluğa yönelik, psikososyal eğitim müdahalesi, akut ve kronik stres tepkilerini anlatan broşür dağıtımı, halka açık forumların düzenlenerek gerek toplum liderleri gerek ruh sağlığı uzmanlarının katılımıyla tartışmaların düzenlenmesi, radyo-televizyon ve diğer medya organlarınca afetler sonrasında ortaya çıkan sıkıntılara yönelik bilgi yayılması gibi yöntemler kullanılarak yapılabilir. Bu yöntemlerde amaç; ruh sağlığı koruyucu kapasitesinin harekete geçirilmesi ve ortaya çıkabilecek afet durumlarında halkın olumsuz durumlara karşı olumlu başa çıkma yollarını kullanmalarını sağlamaktır (Reyes and Elhai, 2004). ...
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Article
Abstract Disasters are characterized by the inability of the society to cope with sudden, unpredictable onset, large numbers of people affected by economic, environmental losses and destructive effects. It affects individuals (e.g. children, parents, first responders), emergency aid, nongovernmental organizations (e.g. medical emergency teams, public health organizations, fire brigades) and society. Disasters are associated with a significant psychological burden for affected people. Psychosocial care aims to address mental health problems and needs. It includes all support and care for the psychological well-being and health of affected people during and after a disaster for individuals as well as for communities. Psychosocial care interventions are needed in the context of disasters or crises in the case of chemical, biological, radiological or nuclear (CBRN) events. However, it is important to systematically investigate the impact on psychosocial care as CBRN events are a separate theme in emergency planning and disaster preparedness. In this study, general rules of psychosocial care in CBRN events are discussed and different psychosocial conditions in CBRN events are to be explained. General conclusion after examining literature studies related to psychosocial care in CBRN is that literature examined is either similar or complementary to the guidelines on psychosocial care. However, there are some significant differences on communication, exposure to CBRN agents, contamination and special preparation requirements for CBRN events. In our country, there are very few studies on psychosocial effects and psychosocial care of CBRN events. It is suggested that field studies could do a great contribution to the literature. Keywords: CBRN, Psychosocial Care, Education
... 65,66 The common interventions in mental health include psychological first aid, crisis counseling, psychoeducation, family outreach, social support, psychological debriefing (eg, critical event stress debriefing), and techniques for anxiety reduction. [66][67][68][69][70][71] During mental health intervention, clinicians should assess and monitor risk and protective factors across all phases of an emergency and disaster. 72 ...
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Article
In December 2019, a novel coronavirus causing severe acute respiratory disease occurred in Wuhan, China. It is an emerging infectious disease with widespread and rapid infectiousness. The World Health Organization (WHO) declared the coronavirus outbreak to be a public health emergency of international concern on January 31, 2020. Severe COVID‐19 patients should be managed and treated in a critical care unit. Performing a Chest X‐ray/CT can judge the severity of the disease. The management of COVID‐19 patients includes epidemiological risk and patient isolation; treatment entails general supportive care, respiratory support, symptomatic treatment, nutritional support, psychological intervention, etc. The prognosis of the patients depends upon the severity of the disease, the patient's age, the underlying diseases of the patients, and the patient's overall medical condition. The management of COVID‐19 should focus on early diagnosis, immediate isolation, general and optimized supportive care, and infection prevention and control. This article is protected by copyright. All rights reserved.
... A recent empirical review of disaster mental health outcomes suggests that reactions to events could be defined into the following categories: specific psychological problems (such as PTSD), nonspecific distress symptoms, health problems and concerns, chronic problems in living, psychosocial resource losses, and problems specific to youths (Reyes and Elhai, 2004). Many of these issues, like nonspecific distress, will be resolved without the hospital needing to provide services while other symptoms, such as PTSD and acute anxiety, may require immediate psychiatric intervention and hospitalization. ...
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Article
Sustainability is a framework for exploring a community within its broadest possible context, and looking at hazards and disasters as integral parts of the much larger environment in which it exists. Community represents an integrated paradigm of social, cultural, economic, and environmental spheres in which people participate simultaneously. As a result, physical and mental disaster health impacts are inseparable. To build surge capacity, hospitals need to move from theory to practice suggesting a resource-based, community participatory model. By partnering with community resources, the hospital becomes more resilient and, in the case of mental health and psychosocial impacts, the hospital facility and the continuation of its services become a fundamental part of the resiliency of the community. A disaster mental health ped-agogical intervention was piloted by the Center for Integrated Disaster Preparedness and the Colorado Hospital Association and an evaluation of the intervention was conducted to determine strengths and gaps in resources that remain. The results suggest that resources in the community represent the most readily available opportunities for capacity building and for bridging many gaps. The dynamics of supporting relationships will be explored and two case studies, a community hospital and teaching hospital, will be presented as examples of success.
... Incorporation of religion/spirituality into practice has specific implications for the widely used practice of psychological first aid (PFA). PFA is a set of pragmatic interventions and principles for responding to trauma-related emotional distress Reyes and Elhai 2004;Young 2006). Consideration of an individual's religion and practices is particularly relevant for specific elements of PFA, including listening, coping and stress management, social support, and referral to formal systems of care. ...
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Article
This study examined religious and spiritual aspects of disaster experience among 379 survivors of the 9/11 attacks on New York City’s World Trade Center. Interviews conducted 35 months after the disaster provided structured diagnostic assessments of psychiatric disorders and specific detail of demographic characteristics, experience of the disaster, and variables related to religion and spirituality. The study participants overwhelmingly identified with a specific religion. The disaster appeared to have only modest effects on strength and importance of religion/spirituality, and changes were predominantly positive. Specific religions and faith groups differed in their disaster experience in important ways.
... Several interventions, either immediately and/or longer-after a natural disaster, designed to bolster community resilience, address COR variables. Their hallmark programmatic features are to teach community members adaptive coping skills in the face of resource loss (Reyes & Elhai, 2004). Applying similar interventions after a technological disaster such as the Deepwater Horizon oil spill may help reduce psychological distress and prevent subsequent suicide proneness. ...
Article
The current study applied the Conservation of Resources (COR) disaster theory to explain suicide proneness after the Deepwater Horizon oilrig explosion. We had 213 residents in affected areas with complete measures of resource stability, distress, and coping 18 months after the disaster. Overall, 10% expressed clinically elevated suicide proneness. The COR model had excellent fit that accounted for 41% of inter-individual differences in suicide proneness. Aligned with theory, residents lacking resources who experienced distress and coped by avoidance were more suicide-prone. Fostering resource stability and constructive coping after catastrophe may help reduce suicide proneness and prevent suicide in disaster-impacted citizens.
... It is most delicate and important first step in caring the disaster survivors. The basic aim of early phase intervention is to detect the survivors, then provide them protection, direction, care and triage (Reyes & Elhai, 2014). The detection includes locating the survivors of disaster and knowing their health damages, whereas the protection saves them from further damages. ...
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Article
Disaster either natural or man-made can exacerbate a wide range of mental health problems. Regardless of negative health consequences, disasters are still manageable through proper planning and preparation. However, the nature of mental health recovery in post-disaster scenario varies broadly; therefore, more research is required to understand the dynamics of mental health recovery after disasters. This study is a review of current state of literature on disaster mental health. By adopting a non-systematic narrative review methodology, this study has reflected on existing literature for understanding the concepts of post-disaster recovery in general and post-disaster psychological health recovery in specific. Moreover, this review has discussed approaches and services to post-disaster psychological health recovery. One of unique feature of this study is that it has discussed how to "help the helper" during disaster. This review has focused on short and long term health effects of natural and man-made disasters. The findings of this review revealed that mental health recovery is multifold concept and it has evolved with passage of time. Mental health approaches and services are a series of ongoing activities, which vary according to type of disaster and characteristics of survivors. The disaster recovery plan should include helping disaster health workers, as they are equally vulnerable. The post-disaster mental health recovery is an important component of public health system. It is the mean through which survivors can restore their healthy life and contribute towards socioeconomic development of society as a whole.
... It is most delicate and important first step in caring the disaster survivors. The basic aim of early phase intervention is to detect the survivors, then provide them protection, direction, care and triage (Reyes & Elhai, 2014). The detection includes locating the survivors of disaster and knowing their health damages, whereas the protection saves them from further damages. ...
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Disaster either natural or man-made can exacerbate a wide range of mental health problems. Regardless of negative health consequences, disasters are still manageable through proper planning and preparation. However, the nature of mental health recovery in post-disaster scenario varies broadly; therefore, more research is required to understand the dynamics of mental health recovery after disasters. This study is a review of current state of literature on disaster mental health. By adopting a non-systematic narrative review methodology, this study has reflected on existing literature for understanding the concepts of post-disaster recovery in general and post-disaster psychological health recovery in specific. Moreover, this review has discussed approaches and services to post-disaster psychological health recovery. One of unique feature of this study is that it has discussed how to "help the helper" during disaster. This review has focused on short and long term health effects of natural and man-made disasters. The findings of this review revealed that mental health recovery is multifold concept and it has evolved with passage of time. Mental health approaches and services are a series of ongoing activities, which vary according to type of disaster and characteristics of survivors. The disaster recovery plan should include helping disaster health workers, as they are equally vulnerable. The post-disaster mental health recovery is an important component of public health system. It is the mean through which survivors can restore their healthy life and contribute towards socioeconomic development of society as a whole.
... It is most delicate and important first step in caring the disaster survivors. The basic aim of early phase intervention is to detect the survivors, then provide them protection, direction, care and triage (Reyes & Elhai, 2014). The detection includes locating the survivors of disaster and knowing their health damages, whereas the protection saves them from further damages. ...
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Article
Disaster either natural or man-made can exacerbate a wide range of mental health problems. Regardless of negative health consequences, disasters are still manageable through proper planning and preparation. However, the nature of mental health recovery in post-disaster scenario varies broadly; therefore, more research is required to understand the dynamics of mental health recovery after disasters. This study is a review of current state of literature on disaster mental health. By adopting a non-systematic narrative review methodology, this study has reflected on existing literature for understanding the concepts of post-disaster recovery in general and post-disaster psychological health recovery in specific. Moreover, this review has discussed approaches and services to post-disaster psychological health recovery. One of unique feature of this study is that it has discussed how to "help the helper" during disaster. This review has focused on short and long term health effects of natural and man-made disasters. The findings of this review revealed that mental health recovery is multifold concept and it has evolved with passage of time. Mental health approaches and services are a series of ongoing activities, which vary according to type of disaster and characteristics of survivors. The disaster recovery plan should include helping disaster health workers, as they are equally vulnerable. The post-disaster mental health recovery is an important component of public health system. It is the mean through which survivors can restore their healthy life and contribute towards socioeconomic development of society as a whole.
... Downloaded from effects of disasters, initial public health support, such as facilitating community development, restoring livelihoods, providing psychosocial support to inform people and mobilising community partnership, is important. [27][28][29] This study also suggested the importance of initial public health support, particularly within the first month postdisaster, in reducing indirect health effects of a disaster. ...
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Background: Evidence on the indirect health impacts of disasters is limited. We assessed the excess mortality risk associated with the indirect health impacts of the 2011 triple disaster (earthquake, tsunami and nuclear disaster) in Fukushima, Japan. Methods: The mortality rates in Soma and Minamisoma cities in Fukushima from 2006 to 2015 were calculated using vital statistics and resident registrations. We investigated the excess mortality risk, defined as the increased mortality risk between postdisaster and predisaster after excluding direct deaths attributed to the physical force of the disaster. Multivariate Poisson regression models were used to estimate the relative risk (RR) of mortality after adjusting for city, age and year. Results: There were 6163 and 6125 predisaster and postdisaster deaths, respectively. The postdisaster mortality risk was significantly higher in the first month following the disaster (March 2011) than in the same month during the predisaster period (March 2006-2010). RRs among men and women were 2.64 (95% CI 2.16 to 3.24) and 2.46 (95% CI 1.99 to 3.03), respectively, demonstrating excess mortality risk due to the indirect health effects of the disaster. Age-specific subgroup analyses revealed a significantly higher mortality risk in women aged ≥85 years in the third month of the disaster compared with predisaster baseline, with an RR (95% CI) of 1.73 (1.23 to 2.44). Conclusions: Indirect health impacts are most severe in the first month of the disaster. Early public health support, especially for the elderly, can be an important factor for reducing the indirect health effects of a disaster.
... 4 Brief psychosocial interventions that are designed to reduce distress, normalize emotional responses, and provide access to community resources 20 can provide immediate psychological benefit to all survivors of disasters. 20 An intervention commonly applied in the early postdisaster phases is psychological first aid. 4,21 Elements of psychological first aid include establishment of initial contact with survivors in a compassionate manner, enhancing immediate and ongoing safety, providing emotional and physical comfort, protecting survivors from further harm, reducing disaster-related anxiety, listening and understanding survivors' ...
Article
No part of the world is immune from major disasters—be they natural disasters, industrial and technological accidents, or intentional human-caused incidents including acts of terrorism. Therefore, disaster preparedness is of paramount importance for all communities everywhere. Several decades of mental health research regarding disasters have generated essential data informing community response to the mental health needs of survivors of disaster. This research has generated principles for disaster mental health response and informed the development of operationalized procedures for the response using an established framework for emergency and medical response to mass casualty incidents. This article first reviews the research foundation for these principles and operationalized procedures and then summarizes recommendations for conducting an organized disaster mental health response.
... The SMHT has gained considerable experience in frontline early intervention missions that were conducted in war zones and in humanitarian military missions sent to natural disaster areas. These interventions were aimed at lowering the severity of symptoms occurring immediately after traumatic events as a way to shorten the recovery time [1][2][3] and reduce later symptoms of post-traumatic stress disorder (PTSD) [4]. ...
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The following is a case study of the blizzard of October 2014, an Israeli rescue team, the Special Mental Health Team (SMHT) of the Israeli Defense Forces Medical Corps, was sent to the disaster area to rescue Israeli trekkers. The SMHT intervention was provided immediately following the traumatic events with the purpose of lowering stress-related symptoms, shortening recovery time and reducing post-traumatic stress disorder symptoms that could occur in the future. Forty Israeli trekkers were assessed by SMHT: 75 % (n = 30) had mild acute stress reaction (ASR) symptoms and 25 % (n = 10) had severe acute stress disorder (ASD) symptoms. All participating trekkers receiving the intervention as a way to alleviate symptoms reported no symptoms of ASR and ASD following the intervention. Trekkers with mild ASR reported full recovery after 1 week and trekkers with ASD reported full recovery after 3 months. This case study describes the psychological intervention conducted by SMHT for the surviving trekkers following the blizzard and aims to extend the knowledge base of mental health intervention at the early phases of disaster. A research study should be conducted to develop a measurement tool capable of evaluating the effect of a short-term intervention conducted in the field.
... As with all disasters, high levels of psychosocial distress can occur when lives and livelihoods are lost. Psychosocial distress caused by natural disasters includes: stress (PTSD and acute stress disorder), depression, anxiety (Cohen 2002;Reyes & Elhai 2004;Warsini et al. 2014c), all of which result in decreased quality of life (Warsini et al. 2014c). Solastagia, a form of environmental distress (Warsini et al. 2014a), may also result from volcanic eruptions. ...
Article
Mount Merapi in Indonesia is the most active volcano in the world with its 4-6-year eruption cycle. The mountain and surrounding areas are populated by hundreds of thousands of people who live near the volcano despite the danger posed to their wellbeing. The aim of this study was to explore the lived experience of people who survived the most recent eruption of Mount Merapi, which took place in 2010. Investigators conducted interviews with 20 participants to generate textual data that were coded and themed. Three themes linked to the phenomenological existential experience (temporality and relationality) of living through a volcanic eruption emerged from the data. These themes were: connectivity, disconnection and reconnection. Results indicate that the close relationship individuals have with Mount Merapi and others in their neighbourhood outweighs the risk of living in the shadow of an active volcano. This is the first study to analyze the phenomenological existential elements of living through a volcanic eruption.
... As with other types of major incidents or disasters the effects of flooding on people's health, relationships and well-being can be extensive (North, 2014). The aftermath of a disaster is a time when survivors can experience many psychosocial symptoms such as stress, grief, depression and anxiety (Cohen, 2002; Reyes and Elhai, 2004; Adams et al., 2002; Norris et al., 2002; Warsini et al., 2014; Neria et al., 2008). The psychosocial impact may be exacerbated and prolonged by personal and property losses, relocation and disruption to social support networks and daily activities (Mitchell et al., 2008; Nikapota, 2006). ...
Article
Purpose – Following recent flooding in New Zealand a brief review of research on psychosocial impacts of flooding was undertaken to identify lessons. The paper aims to discuss this issue. Design/methodology/approach – A pragmatic review of the literature concerning psychosocial or mental health impact following flooding incidents in locations with similarities to New Zealand identified. In total, 12 papers from between 2008 and 2015 were reviewed to identify lessons for New Zealand. Findings – The review findings illustrate how floods can have great impacts on people’s psychosocial needs and mental health. The extended timeframe and disruptive nature of the impacts of flooding are such that the effects of secondary stressors are highly significant as they prolong the welfare, physical and psychosocial needs of those affected. Originality/value – This brief review provides important insights into the psychosocial impacts of flooding by examining research from similar areas to New Zealand.
... gnitive symptoms. This heightened emotional state is similar to classical fight/flight/freeze reaction of stress. Affected person may not be in a position to think and act rationally during disaster. Similar to medical first aid, psychological first aid techniques can be performed by minimally trained nonprofessionals within the affected community. [50] Disaster relief workers need to be trained in assessing the high-risk survivors. The assessment need to be initiated by the relief worker for assessment of: a. Dangers to self and others b. Disoriented to time/place/person c. Death of family member/s in disaster d. Direct threat to life because of disaster e. Disaster related significan ...
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Disaster mental health is based on the principles of 'preventive medicine' This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six 'R's such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well-established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health.
... gnitive symptoms. This heightened emotional state is similar to classical fight/flight/freeze reaction of stress. Affected person may not be in a position to think and act rationally during disaster. Similar to medical first aid, psychological first aid techniques can be performed by minimally trained nonprofessionals within the affected community. [50] Disaster relief workers need to be trained in assessing the high-risk survivors. The assessment need to be initiated by the relief worker for assessment of: a. Dangers to self and others b. Disoriented to time/place/person c. Death of family member/s in disaster d. Direct threat to life because of disaster e. Disaster related significan ...
Full-text available
Article
Disaster mental health is based on the principles of ‘preventive medicine’ This principle has necessitated a paradigm shift from relief centered post-disaster management to a holistic, multi-dimensional integrated community approach of health promotion, disaster prevention, preparedness and mitigation. This has ignited the paradigm shift from curative to preventive aspects of disaster management. This can be understood on the basis of six ‘R’s such as Readiness (Preparedness), Response (Immediate action), Relief (Sustained rescue work), Rehabilitation (Long term remedial measures using community resources), Recovery (Returning to normalcy) and Resilience (Fostering). Prevalence of mental health problems in disaster affected population is found to be higher by two to three times than that of the general population. Along with the diagnosable mental disorders, affected community also harbours large number of sub-syndromal symptoms. Majority of the acute phase reactions and disorders are self-limiting, whereas long-term phase disorders require assistance from mental health professionals. Role of psychotropic medication is very limited in preventing mental health morbidity. The role of cognitive behaviour therapy (CBT) in mitigating the mental health morbidity appears to be promising. Role of Psychological First Aid (PFA) and debriefing is not well‐established. Disaster management is a continuous and integrated cyclical process of planning, organising, coordinating and implementing measures to prevent and to manage disaster effectively. Thus, now it is time to integrate public health principles into disaster mental health.
... PFA is a set of empirically derived standards that provide first responders and receivers with a framework to support afflicted children and adults after disasters with practical and social support with linkages to mental health care. 52 The aim of PFA is "to reduce initial distress, meet current needs, promote flexible coping and encourage adjustment." 53 There is a general shortage of first responders and receivers trained in PFA, no standard PFA curricula, and no widely accepted model for training health care and public health workers in PFA competencies. ...
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Abstract This article reviews the literature pertaining to psychological impacts in the aftermath of technological disasters, focusing on the immediate psychological and mental health consequences emergency department physicians and first responders may encounter in the aftermath of such disasters. First receivers see a wide spectrum of psychological distress, including acute onset of psychiatric disorders, the exacerbation of existing psychological and psychiatric conditions, and widespread symptomatology even in the absence of a diagnosable disorder. The informal community support systems that exist after a natural disaster may not be available to communities affected by a technological disaster leading to a need for more formal mental health supportive services.
... However, steps are taken in the right direction: the American Psychological Association (APA) for example stated an explicit commitment to the use of evidence-based practice within all aspects of the profession [38,39]. Moreover, the lack of uniform terminology in the field of psychology leads, in the case of PFA, to several definitions, frameworks, and interventions [1,12,40,41]. In order to make evidence-based research for PFA easier, an international consensus should be reached on the definitions of these concepts. ...
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Providing psychological first aid (PFA) is generally considered to be an important element in preliminary care of disaster victims. Using the best available scientific basis for courses and educational materials, the Belgian Red Cross-Flanders wants to ensure that its volunteers are trained in the best way possible. To identify effective PFA practices, by systematically reviewing the evidence in existing guidelines, systematic reviews and individual studies. Systematic literature searches in five bibliographic databases (MEDLINE, PsycINFO, The Cochrane Library, PILOTS and G-I-N) were conducted from inception to July 2013. Five practice guidelines were included which were found to vary in the development process (AGREE II score 20-53%) and evidence base used. None of them provides solid evidence concerning the effectiveness of PFA practices. Additionally, two systematic reviews of PFA were found, both noting a lack of studies on PFA. A complementary search for individual studies, using a more sensitive search strategy, identified 11 237 references of which 102 were included for further full-text examination, none of which ultimately provides solid evidence concerning the effectiveness of PFA practices. The scientific literature on psychological first aid available to date, does not provide any evidence about the effectiveness of PFA interventions. Currently it is impossible to make evidence-based guidelines about which practices in psychosocial support are most effective to help disaster and trauma victims.
... PFA is a set of empirically derived standards that provide first responders and receivers with a framework to support afflicted children and adults after disasters with practical and social support with linkages to mental health care. 52 The aim of PFA is "to reduce initial distress, meet current needs, promote flexible coping and encourage adjustment." 53 There is a general shortage of first responders and receivers trained in PFA, no standard PFA curricula, and no widely accepted model for training health care and public health workers in PFA competencies. ...
Article
This article reviews the literature pertaining to psychological impacts in the aftermath of technological disasters, focusing on the immediate psychological and mental health consequences emergency department physicians and first responders may encounter in the aftermath of such disasters. First receivers see a wide spectrum of psychological distress, including acute onset of psychiatric disorders, the exacerbation of existing psychological and psychiatric conditions, and widespread symptomatology even in the absence of a diagnosable disorder. The informal community support systems that exist after a natural disaster may not be available to communities affected by a technological disaster leading to a need for more formal mental health supportive services.
... In terms of individual characteristics which influence people's ability to cope with loss and trauma, George Bonanno (whose work is encountered elsewhere in this review) features as a key researcher in the field of 'human resilience'. He believes that resilience is a dimension of human experience within the field of loss and trauma that has been underestimated in the past (Bonanno 2004 Taking a psychotherapeutic approach Reyes and Elhai (2004), feel that training in treating trauma-related disorders is not sufficient preparation for conducting psychosocial disaster intervention. They add to the view that early interventions may not be helpful and that emotional reactions may take several weeks to show. ...
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This paper reports on a systematic literature review of bereavement and bereavement care commissioned in Scotland to assist the development of policy and practice there. The review identified and appraised papers from a range of health and social care settings in which bereavement care b a feature, such as acute, hospice- and hospital-based care including neonatal and obstetric, community and primary care, mental health and learning disability services, and care of older people, families and children. Specific types of death were also reviewed, eg traumatic and from (tiseases such as HIV/AIDS. Key messages for each setting and type were identified and overall themes were drawn out which cut across at settings and types. These, it is proposed, represent important features of bereavement and bereavement care which, if acknowledged and addressed, could enhance services.
... In addition to natural disasters, other disasters including transportation accidents (e.g., train wrecks and plane crashes), technological accidents (e.g., toxic smoke from the furnaces of industry, emissions from power plants), community violence (e.g., school shootings, restaurant murder sprees), and bombings (e.g., Oklahoma City, U.S. embassies) often are discrete public events and involve victims from more than one family. Disasters of this nature (e.g., train wrecks or emissions from power plants) may share many characteristics (e.g., the result of human error and technological failure) with traumatic accidents; however, they often draw more media and public attention due to their marked human and financial tolls resulting from events characterized by images of carnage and massive destruction of property (Reyes & Elhai, 2004;Scotti et al., 1995). ...
... Any type of disaster, whether natural or not, results in a multidimensional impact on a large number of people. The aftermath of a disaster is a time when survivors experience many psychosocial symptoms such as stress, grief, depression, and anxiety (Cohen, 2002;Reyes & Elhai, 2004). The psychosocial impact is exacerbated and prolonged by personal and property losses, relocation, and disrupted social support networks and daily activities (Mitchell, Witman, & Taffaro, 2008;Nikapota, 2006). ...
The aim of this review was to identify the psychosocial impact of natural disasters on adult (over the age of 18 years) survivors. Databases searched included PsycInfo, CINAHL, Proquest, Ovid SP, Scopus, and Science Direct. The search was limited to articles written in English and published between 2002 and 2012. A total of 1,642 abstracts and articles were obtained during the first search; 39 articles were retained. The results indicate that PTSD is the most-studied psychosocial impact after a disaster. Mental health nurses have a significant role to play in supporting survivors and can assist with the development of resilience in community members.
... las crisis pueden ser desencadenadas por transiciones propias del ciclo vital o por eventos circunstanciales tales como desastres naturales o provocados por el hombre. Estos últimos son los que ocupan esta revisión y tienen características distintivas, como son el hecho de afectar a muchas personas al mismo tiempo, tener un carácter repentino, un impacto poderoso, percepción de incapacidad de control, pérdida de la confianza de las víctimas y persistencia de los efectos (Reyes y Elhai, 2004; Roberts, 2000). Según Figueroa et al. (2010), aunque no necesariamente todas las víctimas de desastres sufrirán psicopatologías, la atención en primeros auxilios psicológicos y la intervención con terapias centradas en el trauma son una tarea indispensable para disminuir el impacto del desastre. ...
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This article describes some of the concepts of care strategies after disasters that have been published over the past 5 years in PsicoRedalyc and APA PsyArticles. From the review highlights the fact that Hispanic publications are minimal in contrast to the more than 100 disasters occurred between 2001 and 2010. Systematized models are also presented on the experience of disasters occurring around the world and which have generated different guidelines for the care of mental health professionals to victims. It distinguishes a trend in the application of techniques of cognitive-behavioral therapy and an interest in the prevention of Post Traumatic Stress Disorder.
... and regain their normal pre-disaster conditions, psychological reactions also begin to return to normal functioning (Norris, 2005;Reyes & Elhai, 2004). However, in a small percentage of people, long-term psychological impacts of disasters can be experienced. ...
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The aim of this study was to explore the experiences of people who lived through Cyclone Yasi on 3 February 2011. Data from two open-ended questions (Q1: n=344; and Q2: n=339) within a survey completed by 433 residents of cyclone-affected areas between Cairns and Townsville, Australia, were analysed using a qualitative, thematic approach. Experiences were portrayed in three main themes: (1) living in the mode of existential threat describes survivors' sense of panic and feeling at the mercy of nature as they feared for their life; (2) unforgettable memories describe feelings of emotional helplessness and the unimaginable chaos that the cyclone wrought; and (3) centrality of others shows how community support and closeness helped alleviate losses and uncertainty. A critical finding from this study was the negative role of the media in escalating fears for life prior to and during the cyclone, highlighting the need for government, community leaders, and health professionals to have a media plan in place to ensure that disaster warnings are taken seriously without inciting unnecessary panic. Although survivors experienced extreme vulnerability and a threat to life, the disaster also brought communities closer together and connected family, friends, and neighbours through the caring, support, and help they offered each other. This highlights the central role of others during the recovery process and underlines the importance of promoting and facilitating social support to aid recovery post disaster.
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The prevalence of mental health problems in the general population during a public calamity is high. In calamities, the number of patients who present with mental disorder outbreaks or crises may increase, but the necessary support systems to help them may be impaired if they have not been planned for. Although there are several models for addressing psychiatric emergencies, the general rules are the same, especially when it comes to making these services easily available to the affected population. In this article, we seek to review and present recommendations for the management of psychiatric emergencies in situations of public calamity, including disasters, physical and medical catastrophes, epidemics, and pandemics.
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Introduction: The efficient disaster response will depend primarily on effectiveness of training and re-training of specialized Disaster Response Forces in all dimensions of disaster management that includes psychosocial disaster preparedness. Therefore, NIMHANS and NIDM, collaboratively conducted ToT workshop on psychosocial care in disaster management for NDRF personnel. Methods: The study adopted quasi experimental design with post only research design. There were 20 participants who were part of the training program. The content of the program includes the disaster resilience, need, importance and techniques of psychosocial care; and role of the NDRF personnel in provision of psychosocial care in disaster management. A semi structured questionnaire consisting of socio demographic profile, Overall evaluation of workshop, psychosocial aspects in Disaster Management was developed for assessing the effectiveness of the program. Descriptive statistics was carried out to analyze the data. Results: Majority of the participants found the content of the program from very good to excellent, very well structured and organized. Overall impression of the program was reported as very good to excellent by most of the participants. Conclusion: Integration of psychosocial care services to NDRF personnel in disaster management would equip them to deal with the psychosocial issues effectively. There is also a need to train all the battalions of NDRF as an effective and efficient disaster response force that can deal with the immediate psychosocial impact on survivors of disasters.
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We live in the twenty-first century with the frequent presence of the violent discontinuity in the mankind’s daily life. We call Disruptive this violent event that promotes experiences by placing it against disorganizing extreme situations.
Article
Background: After two strong earthquakes in the Emilia region in Italy, many HCWs had to deal with the psychological consequences of the aftershocks. Objective: The aims of this case study were a) to describe the psychosocial condition of the HCWs affected by the earthquake; b) to present an intervention immediately after the earthquake on HCWs in a post-disaster situation using a mixed-method approach. Methods: A mixed-method study was conducted collecting qualitative data (during Group Counselling sessions) and quantitative data (through questionnaires). Results: The results suggested that the impact of the earthquake was very strong, as more than 80% perceived at least a severe impact event capable of altering their ability to function; most of the thoughts and feelings were related to death and fear. Conclusions: This study adds knowledge about how to plan interventions aiming to help those workers at both individual and organisational level.
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Disasters severely disrupt or destroy environments on which people depend for their survival, and they may thus have extensive social and psychological consequences. The origin of a disaster may lie in natural phenomena such as heat, wind, precipitation, fire, tides, and seismic activity (e.g., droughts, famines, tornadoes, hurricanes, floods, blizzards, wildfires, tsunamis, and earthquakes). Disasters may also be brought about by unusually rapid changes in the prevalence and distribution of life forms, leading to infestations of destructive species and epidemics of infectious disease. Human activities may also cause massive destruction, whether inadvertently or by intent. Technological failures are an increasingly worrisome cause of death and destruction, most notably perhaps in the category of failures of transportation conveyances (e.g., aircraft, ships, trains), but failures of architectural structures can also be massively destructive (e.g., dams, levies, pipelines, and large buildings). Manufacturing that involves explosive or toxic substances also requires technological safeguards that may fail (e.g., chemical plants, oil refineries, and nuclear power plants), and major failures can lead to long-term environmental damage and the injury or death of workers or others living nearby.
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A content analysis of the Journal of Counseling & Development, Journal of Mental Health Counseling, and Counselor Education and Supervision from 1994 to 2014 was conducted to determine traumatology topics and trends. The frequency of trauma articles was low, and the largest category focused on sexual abuse. Few articles addressed terrorism or mass violence. Emerging topics included shared trauma and trauma supervision. Development of consistent nomenclature, trauma training, and specialized trauma journals are recommended to increase publications. © 2017 by the American Counseling Association. All rights reserved.
Article
Wenchuan Earthquake brought severe trauma to the victims' psychological spaces. In this paper, people's psychological spaces are constructed as relationship circles that people's small world relationship network maps on the mentality. Based on the current situation of post-disaster resettlement measures, this paper focuses on the analysis of repeated tearing and reconstruction of victims' post-disaster psychological spaces in different stages. It also points out the extreme threat of the "repeated tearing" phenomenon imposing on the victims' healthy psychological spaces reconstruction. On that basis, corresponding anti-tearing plans on the victims' psychological spaces are further studied from four dimensionalities to reduce secondary psychological damage, namely, the "escaping-disaster disorder" response, "migration disarray" reaction, public activities implementation, post-disaster psychological intervention.
Article
The purpose of this article is to describe examples of near-death and other transpersonal experiences occurring during catastrophic events like floods, wars, bombings, and death camps. To date, researchers have limited their investigations of these transpersonal events to those occurring to seriously ill patients in hospitals, those dying from terminal illnesses, or to individuals experiencing a period of grief after the death of a loved one. Missing is awareness by first responders and emergency healthcare professionals about these transpersonal experiences and what to say to the individuals who have them. Some responders experience not only deaths of the victims they assist, but also deaths of their colleagues. Information about these transpersonal experiences can also be of comfort to them. The examples in this article include a near-death experience during the Vietnam War, an out-of-body experience after a bomb explosion during the Iraq War, a near-death visit to a woman imprisoned at Auschwitz, and two after-death communications, one from a person killed in Auschwitz and another from a soldier during World War I. Also included are interviews with two New York City policemen who were September 11, 2001 responders. It is hoped the information will provide knowledge of these experiences to those who care for those near death, or dying, or grieving because of catastrophic events, and encourage researchers to further investigate these experiences during disasters.
Mental Health and Psychosocial Support (MHPSS) is an important aspect of emergency and disaster management. This covers a wide-range of interventions and services and should be preceded by careful assessment and planning within the local context, which would include the local perceptions of distress and illness, coping mechanisms, and the mapping of the community's capacity to cope. In the Philippines, the National Disaster Coordinating Council MHPSS Sub-committee saw a need to develop a Rapid Assessment Tool for Mental Health and Psychosocial Support in Emergency Settings (MHPSS-RAT) which will provide immediate assessment of the vulnerable population and relevant resources in the first twenty-four hours of onset in mass emergencies and disasters. The tool was based on the Inter-Agency Standing Committee (IASC) guidelines and developed through collaboration with the Department of Health-Health Emergency Management Staff (DOH-HEMS) and consensus of national agencies involved in disaster response, with inputs from local experts and concerned stakeholders. It was designed to allow planners and analysts to easily identify priority areas and provide sufficient information to rapidly design appropriate interventions and programs. It is recommended that further validation and field testing be done once the final draft is approved for national use.
Article
The bombing of the Alfred P. Murrah federal office building in Oklahoma City in 1995 remains the most devastating act of domestic terrorism in U.S. history. This review focuses on the major research findings on posttraumatic stress responses of both victims and the general population in the affected area, the effects on children, and the coping reactions of emergency services personnel in the aftermath of the tragedy.
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Nowadays, interest in the emerging field of disaster psychology has increased significantly after events such as September 1, 2001 in New York, March 11, 2004 in Madrid, or December 26, 2004 tsunami in Asia. Also this interest has been centred in the need to treat rape, assault or other crime or accident victims. The present article shows a revision of the main early psychological approaches and interventions in the immediate response to disaster. Psychological First Aid (PFA) is defined as a group of short, practical and early psychological interventions oriented to relieve and prevent the psychological effects of traumatic events in the short, middle or long term. PFA is useful to offer psychological support in the medium or moderate stressful life events as well as in great intensity ones. The main objectives of PFA are the person emotional stabilization, their connection with the natural social support networks and the decision of the derivation to mental health services. The basic principles and the protocols of PFA are revised and their common characteristics are summarised. Finally, a PFA practical action guide developed and applied in different disasters, war and terrorism settings by the authors is presented (ACERCARSE protocol).
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The Morgan Library at Colorado State University in Fort Collins suffered catastrophic flooding as the result of a historic rain storm and flood that swept through the town on July 28, 1997. This study examines this single library's organizational disaster response and identifies the phenomena that the library's employees cited as their motivation for innovation. Purpose - This study provides an example of a library where a predisaster and post-disaster organizational environment was supportive of experimentation. This influenced the employees' capacity and motivation to create a new tool meant to solve a temporary need. Their invention, a service now called RapidILL, advanced the Morgan Library organization beyond disaster recovery and has become an effective and popular consortium of libraries. Design/methodology/approach - This is an instrumental case study. This design was chosen to examine the issues in organizational learning that the single case of Morgan Library presents. The researcher interviewed employees who survived the 1997 flood and who worked in the library after the disaster. The interview results and a book written by staff members are the most important data that form the basis for this qualitative research. The interviews were transcribed, and key phrases and information from both the interviews and the published book were isolated into themes for coding. The coding allowed the use of NVivo 7, a text analysis software, to search in employees' stories for "feeling'' words and themes about change, innovation, motivation, and mental models. Three research questions for the study sought to learn how employees described their lived experience, how the disaster altered their mental models of change, and what factors in the disaster response experience promoted learning and innovation. Findings - This study investigates how the disruptive forces of disaster can influence and promote organizational learning and foster innovation. Analysis of the data demonstrates how the library employees' feelings of trust before and following a workplace disaster shifted their mental models of change. They felt empowered to act and assert their own ideas; they did not simply react to change acting upon them. Emotions motivate adaptive actions, facilitating change. The library employees' lived experiences and feelings influenced what they learned, how quickly they learned it, and how that learning contributed to their innovations after the disaster. The library's supervisory and administrative leaders encouraged staff members to try out new ideas. This approach invigorated staff members' feelings of trust and motivated them to contribute their efforts and ideas. Feeling free to experiment, they tapped their creativity and provided adaptations and innovations. Practical implications - A disaster imposes immediate and often unanticipated change upon people and organizations. A disaster response urgently demands that employees do things differently; it also may require that employees do different things. Successful organizations must become adept at creating and implementing changes to remain relevant and effective in the environments in which they operate. They need to ensure that employees generate and test as many ideas as possible in order to maximize the opportunity to uncover the best new thinking. This applies to libraries as well as to any other organizations. If library leaders understand the conditions under which employees are most motivated to let go of fear and alter the mental models they use to interpret their work world, it should be possible and desirable to re-create those conditions and improve the ability of their organizations to tap into employees' talent, spur innovation, and generate meaningful change. Social implications - Trust and opportunities for learning can be central to employees' ability to embrace change as a positive state in which their creativity flourishes and contributes to the success of the organization. When leaders support experimentation, employees utilize and value thve connections as much as their professional knowledge. Work environments that promote experimentation and trust are ones in which employees at any rank feel secure enough to propose and experiment with innovative services, products, or workflows. Originality/value - The first of its kind to examine library organizations, this study offers direct evidence to show that organizational learning and progress flourish through a combination of positive affective experiences and experimentation. The study shows how mental models, organizational learning, and innovation may help employees create significantly effective organizational advances while under duress. An original formula is presented in Fig. 1.
Article
The burgeoning field of international disaster psychology has grown over the last 2 decades out of necessity and humanitarian concern, yet it lacks unity and perspective. This article describes the history of international disaster psychology and outlines the contemporary theories and approaches dominating the field, including the clinical, community mental health, and family models. It also sets out the domains of application, which involve people, disaster management processes, and core principles governing disaster management, itself. It goes on to highlight that these models of care and domains of application are presently incorporated in such a way that they often yield a variegated approach to international disaster psychology that too often leads to competition, redundancy, dependencies, and, moreover, lapses in care. In response to these limitations, the authors propose a systems approach to international disaster psychology that unifies both the existing theoretical foundations and the domains of application. Such an approach, it is argued, provides a more cohesive and integrative perspective and, furthermore, offers cultural latitude while simultaneously affirming basic psychological principles and practical issues around sustainability and ethical treatment in international disaster psychology.
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Article
When the Mississippi River and its tributaries flooded St. Louis, Mo, in the spring and summer of 1993, 250 mental health professionals stood ready to help the thousands whose lives the floods would affect. It turned out, however, that most of the flood victims sought instead the support of community leaders they knew and trusted. To meet the need community-based disaster support, disaster intervention training that had been offered to mental health professionals during the summer of 1993 was adapted to train community resource personnel, ranging from clergy to police. The result was Project CERST (Community Resources for Education, Support and Training). CREST's purpose is to maximize mental health resources within communities by community leaders to provide initial crisis intervention and emotional relief services after community-wide disasters, when professional resources are often limited, CREST has also been adapted to other types of crisis intervention. Through Project CREST, many people have received crisis intervention who otherwise would not have sought mental health care.
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Article
Increasingly, trauma and disasters are part of everyday life. Psychiatrists can play an important role in assisting individuals and communities to recover. They bring a unique set of skills and experiences that can be invaluable in minimizing morbidity and facilitating recovery. This paper discusses psychological, physiological, behavioral, and community responses encountered in the aftermath of a disaster. A preventive medicine model of understanding disaster response is discussed in which the psychiatrist delineates traumatic stressors and high-risk populations. The importance of psychiatric participation in disaster preparedness is emphasized. Psychiatric interventions targeted at the various longitudinal phases of disaster response are reviewed.
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Article
On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.
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Article
Results for 160 samples of disaster victims were coded as to sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. In order of frequency, outcomes included specific psychological problems, nonspecific distress, health problems, chronic problems in living, resource loss, and problems specific to youth. Regression analyses showed that samples were more likely to be impaired if they were composed of youth rather than adults, were from developing rather than developed countries, or experienced mass violence (e.g., terrorism, shooting sprees) rather than natural or technological disasters. Most samples of rescue and recovery workers showed remarkable resilience. Within adult samples, more severe exposure, female gender, middle age, ethnic minority status, secondary stressors, prior psychiatric problems, and weak or deteriorating psychosocial resources most consistently increased the likelihood of adverse outcomes. Among youth, family factors were primary. Implications of the research for clinical practice and community intervention are discussed in a companion article (Norris, Friedman, and Watson, this volume).
Article
Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.
Article
The American Red Cross (ARC) Disaster Mental Health Services program uses a multidisciplinary approach to deliver crisis intervention to disaster workers and victims in the aftermath of a hurricane. This model was used for the first time in 1992 in response to Hurricane Andrew and is now a part of all major disaster operations involving the ARC. The author discusses the impetus for the ARC's development of the program, the early implementation of the program, and ongoing challenges in the further development of this approach to disaster Services. Since 1992, the basic level training course has been offered to approximately 3,000 participants. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This monograph was developed to focus attention on emergency worker needs, specifically to (1) increase understanding of the problems faced by emergency workers and the likely health and mental health impact on the workers; (2) encourage emergency organizations to address these needs before, during, and after a disaster; and (3) provide a model training package for teaching emergency organizations and their workers how to prevent, ameliorate, and treat mental health problems arising out of emergency work. Part I discusses in detail different sources of stress for disaster workers and their potential effects. Preventive and treatment strategies are outlined. Part II presents a detailed course designed for mental health trainers to use in helping emergency workers both anticipate stress and prevent it, as well as learn how to get help once they experience stress-related problems. Suggestions are also offered for developing collaborative relationships between emergency organizations and mental health agencies. It is hoped that disaster workers, supervisors, and mental health providers will use the information presented here to attend to workers' emotional needs, both for the protection of the worker and for the optimal care of victims. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes a training program in disaster-relief work for representatives of both mental health and disaster-relief agencies. The program is designed to improve their overall understanding of disaster-relief work and to increase their sensitivity to the emotional needs of disaster victims. Based on the recommendations of a state task force report, the program consists of a workshop that uses videotapes and learning exercises to help participants improve their listening skills, learn problem-solving techniques, become aware of behavioral signs that can alert them to victims' emotional reactions, and familiarize themselves with the work of other relief agencies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Investigated 45 people's self-report accounts of loss and recovery from the 1993 flooding in Illinois, Iowa, and Missouri. Ss' narratives described reliance on activities such as developing an account of the situation, private reflection and prayer, confiding in close others, and community-volunteer and kin support in coping with their losses. Ss also reported that marriages and close relationships that were problematic before the flooding often became more problematic as the flooding worsened. Relative to other Ss, Ss from Hull, Illinois reported more rapid and effective accommodation to their losses and rapidly initiated steps to rebuild and restore homes and lives devastated by the flooding. The narrative evidence pertinent to coping is interpreted in terms of the contribution of account-making, confiding, and social support systems toward the amelioration of psychological impairment due to major losses. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
In this article, the author provides a history of the development of the national plan for disaster mental health, discusses its present state, and provides some suggestions for the future of theory, research, and practice in the field. The focus is on the provision of mental health services in the emergency phase of a disaster, rather than on the long-term follow-up. Consequently, the focus is on the American Red Cross's disaster mental health program and, to a lesser extent, the American Psychological Association's Disaster Response Network. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
the CISD [critical incident stress debriefing] and defusing processes may be defined as group meetings or discussions about a traumatic event or series of traumatic events / the CISD and defusing processes are designed to mitigate the psychological impact of a traumatic event, prevent the subsequent development of posttraumatic stress disorder (PTSD), and serve as an early identification mechanism for individuals who will require professional mental health followup after a traumatic event / describe the development of CISD, its basic components, and its 12-yr history as a preventive intervention for PTSD among high-risk occupational groups the CISD and defusings were developed with 2 main goals: (a) to mitigate the harmful effects of traumatic stress on emergency personnel and (b) to accelerate normal recovery processes in normal people who were experiencing normal reactions to abnormal events / it was believed that the CISD, as a structured small-group process, would be a positive factor in the prevention of posttraumatic stress and PTSD among high-risk occupational groups, specifically firefighters, law enforcement officers, emergency medical workers, disaster response personnel, emergency dispatchers, and public safety personnel (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Stress response syndromes lie between normal adaptive response to natural disasters and more severe forms of psychopathology that may be chronic or episodic, and worsened by exposure to the disaster. The most common psychopathological diagnosis is posttraumatic stress disorder (PTSD); however, depressive states, phobic disorders, reactive psychoses, and adjustment disorders also may be included in this complex. The strategy of restoring the client to predisaster status involves anything possible that may foster the person's own biological, psychological, and social adaptive processes. The major processes used in the psychological strategy are those that influence control processes. This is a phase-oriented treatment in which the tendency to intrusive thinking and overwhelming emotional flooding is counteracted with structuring efforts, and the tendency to maladaptive denial and the numbing of emotions is counteracted with efforts to reduce the inhibitions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
During the 1989 San Francisco earthquake, Red Cross disaster personnel were involved in providing services which put them at risk for developing stress reactions including Post-traumatic Stress Disorder. This article describes the disaster relief effort in San Francisco and Oakland made by Red Cross workers and the debriefing which was provided to these personnel. Mitchell's Model for Critical Incident Stress Debriefing (CISD) was modified to fit the broad spectrum of needs and stresses experienced by disaster relief personnel. The Multiple Stressor Debriefing Model (MSDM) which evolved from this experience is discussed with specific recommendations for mental health workers involved in Debriefing Red Cross and other emergency personnel who face multiple stressors over an extended period of relief operations.
Article
Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.
Article
This paper discusses research findings and their implications regarding children''s responses to community violence. It outlines (1) theory and findings, (2) early intervention and psychological first aid, and (3) treatment approaches following a violent event. In each section we discuss post-traumatic stress, grief, worry about a significant other, and experience with previous trauma. Detailed steps for psychological first aid are outlined according to age and grade level. Intervention strategies are proposed for each category of response with designed interventions for the classroom, the family, the individual, and the group.
Article
In recent years academic scholars have given increasing attention to the importance of strategic measurement systems including both non-financial and financial measures. One of the approaches adopted is that of the balanced scorecard. It is distinct from other strategic measurement systems in that it is more than an ad hoc collection of financial and non-financial measures. It contains outcome measures and the performance drivers of outcomes, linked together in cause-and-effect relationships, and thus aims to be a feed-forward control system. Furthermore, the balanced scorecard is intended not only as a strategic measurement system but also as a strategic control system which can align departmental and personal goals to overall strategy. This paper first examines the extent to which there is a cause-and-effect relationship among the four areas of measurement suggested (the financial, customer, internal-business-process and learning and growth perspectives). The paper then examines whether the balanced scorecard can link strategy to operational metrics which managers can understand and influence. Finally, it discusses and suggests some improvements to the balanced scorecard.
The author describes a training program in diaster-relief agencies. The program is designed to improve their over-all understanding of disaster-relief work and to increase their sensitivity to the emotional needs of disaster victims. Based on the recommendations of a state task force report, it consists of a workshop that makes use of videotapes and learning exercises to help participants improve their listening skills, learn problem-solving techniques, become aware of behavioral signs that can alert them to victims' emotional reactions, and familiarize them with the work of other relief agencies.
Article
The Multiple Stressor Debriefing (MSD) model was used to debrief 112 American Red Cross workers individually or in groups after their participation in the 1994 Los Angeles earthquake relief effort. Two composite case examples are presented that illustrate individual and group debriefings using the MSD model. A questionnaire which evaluated workers' experience of debriefing, was completed by 95 workers. Results indicated that workers evaluated the debriefings in which they participated positively. In addition, as participant to facilitator ratio increased, workers shared less of their feelings and reactions about the disaster relief operation. These findings, as well as more specific issues about debriefing, are discussed.
Article
Project Outreach was a specially designed crisis intervention program funded by the National Institute of Mental Health following the devastating 1972 Agnes flood disaster in the Wyoming Valley of northeastern Pennsylvania. The project was in operation for 32 months and employed 60 individuals primarily specially trained, indigenous nonprofessionals. Utilizing a neighborhood canvassing effort, Human Service Counselors encountered individuals with a wide range of problems ranging in severity and difficulty from those requiring limited assistance from community resources to those involving the need for direct mental health services. Over 25,000 client contacts were made. The project demonstrated that a cadre of local residents can be recruited, selected, and trained within a very short period of time to provide crisis intervention services to disaster victims. Further, Project Outreach has shown that an active, community-based, outreach/case-finding effort can be a highly effective approach in dealing with the problems of disaster victims.
Article
This article highlights some of the core issues in the prevention of PTSD in trauma survivors. A review of some of the noteworthy research is presented along with new directions for research, training, education, and social planning efforts.
Article
Not until 1989 did the Red Cross officially recognize a need for a systematic and organized plan for the mental health needs of disaster survivors. Over the next decade, the Red Cross Disaster Mental Health Services program has developed and evolved to assist both disaster victims and the Red Cross workers who serve them to cope with the overwhelming stresses encountered by both groups in the aftermath of disasters. The Red Cross now coordinates a large and diverse group of mental health professionals from fields of psychology, psychiatry, nursing, social work, marriage and family therapy, and counseling who work together cooperatively. Cross-disciplinary conflicts are minimized by the Red Cross' generic approach to the various mental health professional specialties as functionally interchangeable in performing Red Cross duties. This article reviews the development of this process and describes one local Red Cross chapter's early experience as part of this effort.
Article
The efficacy of psychological debriefing following potentially traumatising events has become extremely controversial. This review aims to identify the issues underlying this controversy and their theoretical, social and political ramifications which are important in other areas of psychiatry and the social sciences. The historical background to the debriefing debate and the (largely negative) results of recent randomised controlled trials (RCTs) are reviewed. Despite the negative results of recent RCTs, psychological debriefing remains the most widely used structured intervention following potentially traumatising events, designed to reduce the incidence of long-term psychiatric morbidity. The clinical relevance these trials and their applicability in vivo is questioned. There are implicit difficulties in conducting rigorous randomised controlled trials of group debriefing, and such trials may be unachievable. Demonstrating the efficacy of debriefing or other preventive interventions presents major challenges to investigators and it is unlikely the controversy will be resolved in the near future.
Despite a long and rich history as a specialty within applied mental health, crisis intervention has, within recent years, been the target of criticism. Singled out for specific criticism has been the intervention referred to as "debriefing." Some authors have not only challenged its effectiveness but have raised the specter that it may cause significant harm. While superficially such arguments appear to have merit, closer scrutiny reveals an antiquated interpretation of even the most fundamental of terms and concepts inextricably intertwined with research based upon applications contrary to the most recent principles, prescriptions, and protocols regarding clinical use. A review of research based upon more extant formulations reveals many crisis intervention practices, including the Critical Incident Stress Debriefing model of "debriefing" and the Critical Incident Stress Management (CISM) model of crisis intervention to be highly clinically effective, indeed. This paper will review the terms and concepts which serve as the foundation of the field of crisis intervention, while subsequently reviewing key research investigations addressing its efficacy. It may be that outcome research directed toward assessing the effectiveness of crisis intervention can prosper from following trails blazed by psychotherapy researchers. The parallels seem striking. It may be that outcome research in crisis intervention (and "debriefing") needs to now focus upon "who" does crisis intervention, to "whom," and in "what specific situations," so as to maximize outcome associated with this clinically effective tool [International Journal of Emergency Mental Health, 2000, 2(4), 211-225].
Article
Reactions to the Oregon disaster follow the psychological patterns reported in previous disasters.6.12,13 Present-day understanding of reactions to disasters is overgeneralized 4.8 with little appreciation for the needs of specific age groups and family constellations. In planning for the psychological first aid of disaster victims, specific cognizance must be taken of their age and family relationship. The infant and young child need to be physically close to their strongest parent. The inappropriate remarks of the older child should be accepted with tolerance and without contributing to a sense of guilt. The excited activity of the teenager must be planned for in any long-term confinement to a shelter and channeled toward involvement in available constructive work. The adult's tendency towards conflict may be better controlled if anticipated. The aged's wish to stay close to the familiar can be dealt with, if the need for strong, direct action in removing them is appreciated. Some new clues of family interaction under stress were uncovered, and these pointed to the pressing need for continued research into human behavior during and after a disaster.
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