Patricia J. Watson

60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981—2001

Abstract 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).

60,000 Disaster Victims Speak: Part II. Summary and Implications of the Disaster Mental Health Research

Abstract 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, interagency 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.

Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence

Abstract Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence–based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid–term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid–term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid–term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self– and community efficacy, 4) connectedness, and 5) hope.

Assessment and treatment of adult acute responses to traumatic stress following mass traumatic events.

Assessment and treatment of acute responses to traumatic stress has received much attention since September 11, 2001. This article elucidates principles of early intervention with adults in the immediate (within 48 hours) and early recovery phase (within the first week). The principles have been drawn from research on risk and recover factors, stress and traumatic stress theory, and expert consensus recommendations. The debriefing model is discussed, and principle interventions of psychological first aid, pharmacology, and mass trauma systems are described. This article concludes with brief guidelines for longer-term interventions and recommendations for future research.

Guidelines for peer support in high‐risk organizations: An international consensus study using the delphi method

Despite widespread adoption of peer-support programs in organizations around the world whose employees are at high risk of exposure to potentially traumatic incidents, little consensus exists regarding even the most basic concepts and procedures for these programs. In this article, consensus refers to a group decision-making process that seeks not only agreement from most participants, but also resolution of minority objections. The aim of the current study was to develop evidence-informed peer-support guidelines for use in high-risk organizations, designed to enhance consistency around goals and procedures and provide the foundation for a systematic approach to evaluation. From 17 countries, 92 clinicians, researchers, and peer-support practitioners took part in a 3-round web-based Delphi process rating the importance of statements generated from the existing literature. Consensus was achieved for 62 of 77 (81%) statements. Based upon these, 8 key recommendations were developed covering the following areas: (a) goals of peer support, (b) selection of peer supporters, (c) training and accreditation, (d) role of mental health professionals, (e) role of peer supporters, (f) access to peer supporters, (g) looking after peer supporters, and (h) program evaluation. This international consensus may be used as a starting point for the design and implementation of future peer-support programs in high-risk organizations.

Practitioner perceptions of Skills for Psychological Recovery: a training programme for health practitioners in the aftermath of the Victorian bushfires

Objective: Following the February 2009 Victorian bushfires, Australias worst natural disaster, the Australian Centre for Posttraumatic Mental Health, in collaboration with key trauma experts, developed a three-tiered approach to psychological recovery initiatives for survivors with training specifically designed for each level. The middle level intervention, designed for delivery by allied health and primary care practitioners for survivors with ongoing mild-moderate distress, involved a protocol still in draft form called Skills for Psychological Recovery (SPR). SPR was developed by the US National Center for PTSD and US National Child Traumatic Stress Network. This study examined health practitioner perceptions of the training in, and usefulness of, SPR. Methods: From a range of disciplines 342 health practitioners attended one of 25 one-day workshops on the delivery of SPR. Perceptions of evidence-based care and attitudes to manualized interventions were assessed at the commencement of the workshop. Following the workshop, participants’ perceptions of their confidence in applying, and perceived usefulness of, each module were assessed. A subset of 20 participants recorded their ongoing use of SPR recording 61 cases. Results: The vast majority of participants rated the SPR modules as useful for survivors of disasters and expressed confidence in implementing the intervention following the training. Participants’ pre-workshop attitudes towards evidence-based care and manualized interventions affected their perceptions of the usefulness of the protocol. The ‘Promoting positive activities’ and ‘Rebuilding healthy social connections’ modules were least influenced by variations in these perceptions. Conclusions: This study provides preliminary evidence that SPR is perceived by health providers from varying disciplines and paradigms as an acceptable and useful intervention for disaster survivors with moderate levels of mental health difficulties. Future SPR dissemination efforts may benefit from focusing on modules with the strongest evidence base and which are most amenable to practitioner acceptance and uptake.

Psychological first aid following trauma: implementation and evaluation framework for high-risk organizations.

International clinical practice guidelines for the management of psychological trauma recommend Psychological First Aid (PFA) as an early intervention for survivors of potentially traumatic events. These recommendations are consensus-based, and there is little published evidence assessing the effectiveness of PFA. This is not surprising given the nature of the intervention and the complicating factors involved in any evaluation of PFA. There is, nevertheless, an urgent need for stronger evidence evaluating its effectiveness. The current paper posits that the implementation and evaluation of PFA within high risk organizational settings is an ideal place to start. The paper provides a framework for a phasic approach to implementing PFA within such settings and presents a model for evaluating its effectiveness using a logic- or theory-based approach which considers both pre-event and post-event factors. Phases 1 and 2 of the PFA model are pre-event actions, and phases 3 and 4 are post-event actions. It is hoped that by using the Phased PFA model and evaluation method proposed in this paper, future researchers will begin to undertake the important task of building the evidence about the most effective approach to providing PFA in high risk organizational and community disaster settings.

Interventions for Individuals After Mass Violence and Disaster: Recommendations from the Roundtable on Screening and Assessment, Outreach, and Intervention for Mental Health and Substance Abuse Needs Following Disasters and Mass Violence

Abstract In August 2003, an international expert panel was convened by the U.S. Department of Health and Human Services and the U.S. Department of Veterans Affairs in Bethesda, Maryland, to discuss outreach and intervention for behavioral health needs following disasters and mass violence. This document is the outgrowth of a paper prepared by the working group on individual interventions that was formed at the roundtable. In this document, we discuss basic considerations regarding individual post-disaster interventions and outreach strategies. We then provide brief overviews of the research base and recommendations concerning interventions for different time periods in the aftermath of mass violence or disaster.

Provider Perspectives on Disaster Mental Health Services in Oklahoma City

Abstract Seven years after the bombing of the Murrah Federal Building in Oklahoma City, 34 individuals affiliated with various organizations were interviewed about their experiences in providing disaster mental health services to victims and the community. Their perspectives elucidated the importance of preparedness, training and education, local control, interagency cooperation, and psychosocial support for providers. Significant conflicts emerged among providers about credentials, referrals, the quality of services provided, and the appropriateness, in this context, of basing services solely on a crisis counseling model. The lack of ongoing needs assessment or evaluation data further fueled the debates. On the basis of the findings, the authors outline several recommendations for planning mental health responses to future terrorist attacks.

Resilience and Mental Health: Religious and spiritual factors in resilience

Introduction This chapter will examine how religion/spirituality plays an important role as a resource used by most people in coping with the immediate, as well as longer-term, consequences of highly stressful or traumatic experiences. First, working definitions of the key concepts of resilience and religion/spirituality will be given. Distinctions are made between definitions for general communications and operational definitions suitable for clinical and research purposes. Spirituality is conceptualized as a dynamic process that is an integral and inseparable part of humanity. A current conceptual model of spirituality as being multidimensional in nature is presented, and core dimensions are described. Findings from a selective review of current studies on religion and/or spirituality and resilience are presented. Four key obstacles, or “spiritual red flags,” are identified, and a group therapy module for addressing them is presented. Finally, conclusions about our current knowledge, as well as recommendations for future clinical and research applications are made. Spirituality is acknowledged as an important part of life by most individuals. Annual Gallup polls consistently show that more than 90% of the US population report a “belief in God,” and approximately 70% report affiliation with a faith community and attending religious services. In addition, religion or spirituality has been consistently linked to positive mental (Nooney & Woodrum, 2002) and physical (Powell et al., 2003) health functioning, as well as increased longevity (Oxman et al., 1995). When mental health services are sought, clergy are most frequently the first point of contact, with more than 40% seeking counseling from them rather than mental health providers (Weaver et al., 1997). In the immediate aftermath of the terrorist attacks of September 11 2001, more than 90% of those surveyed reported that they coped by “turning to religion,” second only to “talking with others,” which was endorsed by 98% (Schuster et al., 2001). However, despite the widely recognized positive aspects of religion or spirituality, there are large gaps in our scientific knowledge of the dynamic processes of spirituality that could explain these relationships.