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The DialogueA QUARTERLY TECHNICAL ASSISTANCE BULLETIN ON DISASTER BEHAVIORAL HEALTHWinter 2007
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Reflections on Common Threads of Disaster:
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Despite the desperate situations in which they lived, families I met were welcoming, and often would not let me depart without an offer of a meal. |
However, meeting the people of Armenia was a pure joy. Despite the desperate situations in which they lived, families I met were welcoming, and often would not let me depart without an offer of a meal. I was encouraged by this generosity of spirit and was impressed by the kindness of a people who had suffered tremendously. Those who had the opportunity were eager to make progress in their lives and worked steadily toward goals that would lift them out of their dire situation.
Programs I have worked on in these parts of the world were often viewed as difficult undertakings. In Afghanistan and Bosnia, for example, due to the hostile nature of the relationships among the ethnic groups throughout and after the wars, a climate of fear, distrust, and hostility remained. Projects implemented in all of these countries provided an environment that nurtured the development of communal ties and the rebuilding of relationships. Families and neighbors assisted one another within their ethnic groups in the reconstruction and recovery process thus reestablishing social relations formerly enjoyed before the disasters that changed their lives. Rebuilding these relations enabled the beneficiaries to lead normal, healthy, productive lives again. Programs were aimed at developing close collaboration between community leaders and the beneficiaries. The people in these communities proved to be the key ingredient to the success of these programs as they walked the road to recovery with other families. Leaders of the ethnic groups were encouraged to meet together to discuss overall project objectives and overcome obstacles to community building and recovery. Painstakingly, progress has been made in some areas of these countries.
The importance of one person walking the road to recovery with another is enormous. Beneficiaries in these countries expressed gratitude for the support they received from the personal contact with agencies providing a helping hand so that they could help themselves. During my visits to towns and villages, I have had the honor of witnessing the healing of men and women who have openly expressed their sorrow, their tears, and their joy in the process of recovery. In Bosnia, I stood with a man named Mahmed as we surveyed his home that was nearly completed after many months of construction. Standing inside the house, he began to point at places where memories had been made; a child's first steps, a brother's proud moment, holidays that had been celebrated. He then began to speak about the war, the destruction, the moment they fled for their lives, the screaming, and the terror. He began to sob while still trying to speak of all that had been lost. We stood for a long time before he was able to collect himself and finally speak solemnly about his gratitude for the home being rebuilt and for the changes and improvements he saw slowly occurring in his village as it came back to life. He knew that life would never be the same, but he was making a beginning, a start at something new.
I have met many such people making a new beginning, never thinking that they would ever need to do so in this lifetime. These individuals are heroes to me; they have courageously overcome obstacles to recovery. Through their heroic efforts, widows have fed children, fathers have raised roofs, children have attended newly reconstructed schools, and doctors have provided medical attention in clinics. This is one of the greatest commonalities among those who have recovered; the courage to heal.
Hurricane Katrina and its devastating destruction created a mass migration of people at a level previously unknown in the United States of America. In so doing, families have been scattered throughout the country and are now displaced people. I never imagined that I would ever work on a disaster of this magnitude in the United States. Tens of thousands of families remain without a durable solution more than 1 year after the disaster. The effect of the disaster is quite similar to those that I have witnessed overseas in that the storm has left families utterly with a myriad of losses. Many of those displaced disaster survivors will require long-term assistance and social support in order to achieve self-sufficiency and a lasting recovery. Many families cannot do this on their own; many families now struggle with grave emotional upheaval and are trying to grapple with all that recovery entails.
In October 2005, the Federal Emergency Management Agency granted $66 million to UMCOR which in turn created Katrina Aid Today, a national case management consortium. This unique initiative brings together a consortium of nine national social service and voluntary organizations and 16 local service agencies working as a team to provide case management services to the most vulnerable survivors and evacuees of the hurricane. It is designed to provide assistance to 100,000 families displaced by Hurricane Katrina. These case managers are assisting those people considered among the most vulnerable after suffering the impact of Hurricane Katrina. These people may have disabilities, may be older adults, single heads of family households, pre-disaster impoverished, newly impoverished, working poor, and those with health problems. Case managers assist survivors by facilitating the creation of recovery plans, identifying unmet needs, and facilitating access to necessary resources; they are allies in recovery. Case management services function as an advocacy tool for survivors in long-term and unmet needs tables.
The survivors of Hurricane Katrina have much in common with those who have suffered from disasters around the globe. The recovery process is happening slowly and in staggered steps as families seek to get their legs under them to take the courageous steps ahead. The heroes in recovery are already emerging as rebuilding begins along the gulf coast of Mississippi and Alabama and in New Orleans. It is estimated that recovery may take 6–10 years before results can be seen. These families will need support every inch of the way as they recover from this country's worst disaster in memory.
I look forward to more of the heroes who survived Hurricane Katrina coming to the fore as the recovery process takes shape. I am sure that our friends in the gulf States will conquer obstacles to rebuilding their lives and emerge victorious. They will encounter many hurdles along the way to recovery, but with good fortune they will not have to go through the process alone. I am encouraged that those individuals called case managers will join the many teams of volunteers and professionals to aid in the recovery process. I am most encouraged that the will to survive is strong and that despite setbacks, these families will one day achieve stability once again.
| "Everything is complex and everything is simple…the complexity of thinking, the simplicity of beholding." Andre Comte–Sponville |
The paradox of understanding that things are simpler than we can imagine and more complex than we can conceive is fully at play in most things associated with disaster mental health (DMH) training. In view of this paradox, finding balance is key. Weighing the importance of describing simple, but unimagined roles for mental health professionals, while describing the complex range of factors associated with multi-cultural community empowerment, public and mental health surveillance, intervention, and recovery planning is a tightrope walk. Trainees may struggle with new conceptualizations of helping behaviors, the anxiety of working in unconventional environments, and engaging non-mental health treatment-seeking individuals of all ages and demographics. Helping trainees shift from complex clinical orientations to fundamental helping behaviors, from an inpatient/outpatient clinical-oriented paradigm to an outreach pragmatic needs-shaped paradigm, and from micropathology-based models to macrocommunity recovery models can be difficult. While there is a place for conventional clinical training related to early intervention and tertiary treatment, generally survivors in need of such services compose about 11–15 percent of a disaster population.
Having been invited to briefly write about DMH training guidelines and considerations for The Dialogue, I hope to achieve the balance of, let us say, a tightrope walker who lives to see another day.
DMH training is shaped primarily by seven factors: 1) trainees' credentials, roles, and experience; 2) when training is delivered; 3) topics and learning objectives; 4) the training process; 5) the time available for training; 6) background and teaching experience of the trainer; and 7) available funding.
Trainees: Trainees should be sanctioned to operate within officially recognized structures. Trainees may include: Mental health professionals (e.g., social workers, psychologists, marriage and family therapists, psychiatric nurses, psychiatrists); medical professionals (e.g., physicians, physician's assistants, nurses working in primary care, family practice, and pediatrics); clergy; fire department and police personnel; school personnel; and, paraprofessionals (e.g., staff of helping organizations, community volunteers, graduate students).
Dr. Marlene Wong, director of crisis counseling and intervention services for the National Center for Child Traumatic Stress, advocates training school personnel using evidence-based programs that have demonstrated benefits to children's health, mental health, and learning as well as enhanced classroom management in the post-idisaster environment. Programs with successful outcomes were designed to have minimal disruption to the work of the classroom and the routines of the school day. Of note is the preparation required before training. Preparing school and district staffs to participate in DMH-related programs requires increasing their level of information and awareness and building skills necessary to develop disaster-related roles and responsibilities.
When training is delivered: Pre-disaster training is optimal. It can serve to coordinate and integrate system-level response as well as provide professional trainees with opportunities to learn about the significant differences between DMH services and conventional clinical services. Ideally, pre-disaster training and drills involve numerous community emergency services. Combining classroom teaching with participation in disaster simulations yields opportunities for operating within an incident command system, networking, operational testing, and team and skill building. In lieu of more comprehensive training, a series of focused and specialized trainings can address a wide range of topics specific to DMH service delivery.
When training takes place in the aftermath of disaster, content is shaped by the temporal phase of the disaster and the topics associated with relevant learning objectives. For example, topics specific to "just-in-time" training given in the immediate aftermath may include psychological first aid, common stress reactions, navigational and engagement strategies, grief work, and identification of high-risk individuals. Training given in the second to fourth week might include topics of acute stress disorder, early intervention modalities, working in the schools, outreach strategies, brief education delivery, and cross-cultural issues. Training in the later stages following disaster might include topics of posttraumatic stress disorder and other chronic reactions to trauma, comorbidities (e.g. depression, substance abuse), treatment protocols, vicarious traumatization, outreach strategies, and helper self-care.
Training topics and learning objectives: Much of the disaster-related research during the past two decades has focused on the impact of disasters, with relatively little research on interventions. Until specific DMH interventions are examined, the existing literature can be used to inform and guide training in disaster-related assessment with regard to individuals at risk for adverse mental health outcomes. Findings in other areas of research (e.g., early intervention) can be reasonably generalized and applied to DMH training.
Specific learning objectives are determined by who is being trained, the identified learning needs, and when the training is delivered. The trainer must often make this judgment, informed by his or her own professional experience.
Processes of training: In addition to content, it is important to consider the process of training. Much of the material in the existing training manuals is dedicated to explaining their topics or content. The complexity of the skills involved in delivering DMH services suggests that the best training must go beyond simply describing the array of disaster reactions, coping behaviors, and various methods of intervention. Two recent inquiries found that the majority of practitioners preferred to observe the demonstration of helping interventions. Allowing trainees to rehearse interventions and receive feedback is helpful in gaining mastery of essential helping skills. Videotapes can be used to enable trainees to see and hear disaster-related stories, survivor and responder reactions and coping efforts, and examples of helping behaviors. Using improvised vignettes, helping skills can be demonstrated with opportunities to practice them and receive performance feedback.
Time allotted for training: The amount of time allotted for training is determined by many variables, however, most training falls into 4, 8, 12, or 16–hour programs. Longer programs can utilize the extended time to create opportunities for planning, team building, networking among participants, role-playing, exercises, and demonstrations of helping behaviors.
Trainers: Generally speaking, most trainers are licensed mental health clinicians or administrators who have disaster experience that includes responding to a range of disasters (natural, human-caused, mass casualties) and communities (urban, rural, ethnic diversity). Exceptions to this rule are speakers who can address specific topics (e.g., resources, administrative methods, cultural characteristics of the community, spirituality, bereavement, treatment modalities). The characteristics of an effective instructor include possessing good communication skills, indepth knowledge of the subject, a positive attitude, patience and flexibility in responding to trainees' learning needs, and skills to manage the class and motivate trainees. In addition, having a conceptual and practiced understanding of the learning process is essential. From classroom setup to conducting a course, skills such as good climate setting, bridging ideas from one section of training to another, facilitating discussion, guiding student practice, clarifying, using interactive learning, and knowing current media presentation technology are important instructor qualities for achieving learning objectives.
Funding: Funding for DMH training may come from many sources, depending on whether the program is sponsored by a government, nonprofit, or private sector agency. Funding from the Federal Government is overseen primarily by the Federal Emergency Management Agency, the Substance Abuse and Mental Health Services Administration, and its Center for Mental Health Services, through various grant mechanisms. Nonprofit funding and private sector funding may involve pharmaceutical companies or local institutional support.
Simplicity of beholding: Whether we query DMH workers or read anecdotal accounts of their helping experiences (see the Summer 2006 issue of The Dialogue), we are often impressed with descriptions of the restorative power of simple attentive behaviors. Reflective listening and nonverbal behaviors such as degree of eye contact, touch, attentive silence, posture, and vocal tone, serve to increase survivors' sense of being understood, supported, and cared for, while reducing alienation that trauma may have caused. Another set of helpful behaviors commonly described by workers and trainers are those related to responding constructively to survivors' pragmatic needs. Such help may be in the form of arranging transportation, child care, obtaining needed supplies, locating missing persons, or help with obtaining food and clothing. These intervention behaviors are not typically addressed in graduate clinical training programs. Because all psychological care begins with physical care, addressing these behaviors is, however, a significant component of disaster mental health training.
Historically, the simplicity of these behavioral interventions has been met with resistance by mental health professionals holding preconceived ideas that DMH training is limited to differential diagnosis, screening tools, and clinical therapy options. If the shift to an outreach pragmatic-needs paradigm cannot be made, such trainees may be better suited for later-stage interventions.
The rejection of an outreach pragmatic-needs paradigm, has in some cases, led to dismissing the important role of paraprofessionals. Many paraprofessionals may arrive at a DMH training already possessing the set of attentive behaviors helpful to survivors. Many obviously learn how to respond appropriately and attentively. Given the shortage of prepared DMH workers in virtually every city and town in the United States, utilization of thoughtful, resourceful, simple care administered by professionals and paraprofessionals alike could ultimately account for a significant increase in the support received and valued by survivors.
Complexity of thought: Mathematician Leslie Lamport observed, "There is a race between the increasing complexity of the systems we build and our ability to develop intellectual tools for understanding that complexity." Under ordinary circumstances, human services are complex and challenging. Disasters are particularly characterized by multiple system failures that, in turn, create unmanageable problems. In the wake of disaster, there is always a sense of the race to understand complexity. DMH training must take into account the complexity of service delivery within view of acutely activated and culturally diverse economic, political, and historical forces.
Training content is dependent on the unfolding disaster, and when, where, by whom, and to whom DMH services are delivered. In addition, comprehensive training must include instruction about navigational, engagement, screening and assessment, referral, and other intervention strategies that help the effort to respond to the needs of survivors of all ages (including emergency responders) who are seen either onsite or offsite at various points of time (ranging from hours to months after the event). In multicultural societies, ethnic diversity must be taken into account if mental health services are to be accepted and efficacious. Aggregate groups (e.g., families, communities, schools, and organizations) present unique system-level access, assessment, and intervention challenges that can be addressed in training. Pre-existing community conditions, resources, and history (e.g., political, economic, and cultural), pre-existing individual resources and history (e.g., mental health, medical, and economic), and the severity of the impact of the disaster on the community and helpers must also be taken into account to make post-disaster training relevant.
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In the wake of disaster, there is always a sense of the race to understand complexity. |
Designing and implementing DMH training is shaped by several factors. This article describes guidelines related to seven specific factors, including the qualifications of trainers, and a belief in the inherent paradox involving DMH training related to simplicity and complexity. For greater detail and references, see: Young, B.H., Ruzek, J.I.,Wong, M., Salzer, M., & Naturale, A. (2006). Disaster mental health training: Guidelines, considerations, and recommendations. In E.C. Ritchie, P.J.Watson, & M.J. Friedman (Eds.), Interventions following mass violence and disasters, (pp. 54-79 ). New York: Guilford Press.
This article was contributed by Bruce H. Young, LCSW, DMH educator and researcher, who provides DMH trainings for Federal, State, and nonprofit agencies both nationally and abroad. He works at the National Center for PTSD in Menlo Park, CA, and currently serves as expert-at-large for the California Disaster Mental Health Coalition.
It is hard enough to imagine why one child would commit suicide, but when a younger sibling commits suicide on the anniversary of his brother's suicide, families are inconsolable. This is the sad tragedy repeated for many American Indian (AI) and Alaska Native (AN) families. AI/AN populations experience suicides at 7 times the rate of other racial groups, with the most at-risk population being ages 15–years. Typically, this is the time for planning one's life and preparing for a productive adulthood, not terminating all hope.
Parents and caregivers of AI/AN youth are often overwhelmed and do not understand the challenge when their children make the decision to end their lives. The personal turmoil of those youth is compounded by the environmental chaos that surrounds many AI/AN families and tribal communities.
Trauma has made many inroads within AI/AN families, tribes, and villages when one considers the historical markers that identify a tribal community today. The modern tribal community is identified by the physical boundaries that reduced tribes to confined locations and the emerging urban tribal communities created with relocation programs. Alaskan villages are now permanent settlements when originally they were established as migration or hunting/fishing camps to take advantage of the multiple sources of food and subsistence.
A tribal community is also identified by the lengthy Federal and State regulations with parameters for who is Indian and who is not; and for what a tribe is and what it is not. These regulations create eligibility criteria for entitlements with limited funding often resulting in inadequate or ineffective services. A tribal community is further identified by the historical efforts of the Federal Government to address the "Indian problem" by establishing programs to either eliminate or assimilate them: First by removing them from their historical homelands and introducing marriage, religion, and formal schooling; second by terminating treaties and undermining AI/AN traditional law and social order; and third by having tribes and villages assume the building of an economic infrastructure without funds or resources.
AI/AN populations have been described as being vulnerable and marginal due to the breakdown of cultural values and belief systems that historically were protective factors. Now the cultural values and belief systems have been almost decimated for many tribal communities. Tribes have not had the opportunity to build the infrastructure and resources to provide preventive care. They have been reduced to competing for Federal dollars in a shrinking funding pool with more families in need.
To compound the problem, there is unprecedented poverty among AI/AN children living in single-parent families. Analysis of the National Child Abuse and Neglect Data System data found higher rates of public assistance among AI/AN families compared to whites.
Poverty contributes to a number of less than desirable environmental conditions that create more stress and trauma. Chronic health problems plague AI/AN children who have 2.8 times the likelihood of developing diabetes than white children. The relationship between childhood obesity and diabetes has surfaced as one of the primary indicators of later health-related injuries and trauma.
It is very difficult for poor parents, and especially poor, single, Indian mothers, to provide the quality of care necessary to address the challenging health problems of AI/AN children. Poverty at this level can be debilitating. It affects the quantity and quality of food available to feed infants and children, leaving some malnourished. Malnutrition can lead to poor physical and brain development. As a result, AI/AN children are at risk for developmental delays due to the lack of adequate nutrition.
Another result of the social conditions in many tribal communities is a high incidence of violent crime. AI/AN women report more domestic violence than women from any other race. One study found AI/AN women were twice as likely to be abused (physically or sexually) by a partner as the average woman. The ability to maintain a healthy, productive life is seriously handicapped by stress and violence that is continuously experienced in the home. This violence contributes to the major mental health problems seen in native youth and children, who often see suicide as a solution to end the violence.
Depression and substance abuse also occur at a high rate in tribal communities. The rates of depression among AI/AN children range from 10–30 percent, while the level of drug or substance abuse can be even higher. It is common for students enrolled in boarding schools to arrive directly from inpatient treatment facilities without benefit of followup care. In addition, children of substance abusing parents are at increased risk for injury due to car accidents, behavioral problems, and neglect, and are more likely to attempt/commit suicide and engage in personal substance abuse behaviors.
Suicide of AI/AN children and youth has been a continuous concern. In 1996, a survey of 13,000 AI/AN adolescents reported that 22 percent of females and 12 percent of males indicated having attempted suicide at some point. This is the highest rate of suicide in the 15–24 years age group for any U.S. population. This age group accounts for 64 percent of all AI/AN suicides. AI/AN males are 4 times more likely to commit suicide than other racial groups, and AI/AN females are 3 times more likely to attempt suicide than other racial groups.
AI/AN children are also victims of abuse and neglect more frequently than other children. In 2002, this is the only group to experience an increase in the rate of abuse or neglect of children under age 15. This is disconcerting when one realizes that AI/AN children make up only 1.2 percent of the U.S. child population. It is easy to understand why AI/AN children are vulnerable and lack resilience for other related traumas.
AI/AN children experience trauma in many ways. For example, AI/AN families lead the Nation in alcohol-related motor vehicle fatalities, in chronic liver disease and cirrhosis due to alcohol abuse, and in homicide. They also lead the Nation in deaths due to complications from diabetes such as infections and amputations.
The average rate of violent crimes that occur annually among AI/AN populations
is more than 2.5 times the national rate for every other race or group in
the United States. Tribes may be experiencing collective trauma and unresolved
issues about survival and lack of power to make significant change. Collective
trauma is common, and recent national events (Oklahoma City bombing,
With this level of trauma, AI/AN children exposed to violence can have significant interference with their ability to develop normally. Traumatic stress can interrupt a native child's emotional development, disrupt normal brain development, and create the inability to respond appropriately in peer-to-peer or intimate relationships. Within the native community, relationships are critical. How one is recognized is based on relationships; to whom they are related, from what clan, band, or society their parents come, and with which home community they identify. Typically, one is not recognized by name but by their relationships or kinship ties to others in the community. In adulthood, these native children have difficulty forming positive relationships with others, and have confusing and explosive expectations about their roles as spouse and parent.
More AI/AN tribes are formally incorporating traditional native practices into the mental health delivery system (e.g., the use of the smudging ceremony can be described as a behavioral intervention). They are also focusing on strength-based principles such as connectivity to community and kinship ties, participation in community events, willingness to commit to spiritual pledges, involvement in social or cultural circles (e.g., warrior society, dance troupe), and community readiness to address concerns of children and youth. Suicide and other traumas are being understood as interrelated and not isolated events. Tribes and native villages, families, and communities are making the commitment to better serve their children.
The Circles of Care (CoC) initiative is a program that is funded by SAMHSA's Center for Mental Health Services (CMHS). This program supports AI/AN communities that are developing initial health service programs for children with serious emotional and behavioral disturbances. The story of the CoC initiative is one that demonstrates the power of thoughtful collaboration for addressing critical health policy issues. Under CoC, CMHS, the Indian Health Service, the National Institute of Mental Health, and the Office of Juvenile Justice and Delinquency Prevention in the U.S. Department of Justice, have provided critical funding and technical assistance to federally recognized tribes and urban AI/AN communities to plan, design, and assess the feasibility of a culturally respectful mental health system of care for their children and families. The initiative represents the collective vision of a large number of AI/AN tribal members, service providers, advocates, researchers, and Federal agency representatives who met as an advisory board regarding potential initiatives to address the unique mental health needs of AI/AN children, adolescents, and their families.
In line with priorities and objectives of the President's New Freedom Commission on Mental Health, the CoC initiative seeks to reduce mental health disparities and increase the cultural competence and effectiveness of systems of care for AI/AN children and families. The initiative bridges the gap from science to service by utilizing a community-based effort that identifies community needs, barriers to accessing services, service system gaps, local protocols for the inclusion of traditional healing, and potential community and outside resources available to address mental health needs.
Suicide and Suicide PreventionFor more information on suicide and suicide prevention, please visit the following Web sites:
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The Indian Country Child Trauma Center (ICCTC) at the Center on Child Abuse and Neglect, University of Oklahoma Health Sciences Center, was established to develop and disseminate evidence-based treatment approaches that are culturally modified for native children who have experienced traumatic events. ICCTC has a nationwide focus that encourages partnerships among the more than 600 tribes, villages, and programs in the continental United States.
The ICCTC is a National Child Traumatic Stress Network Level II Center designed to develop interventions appropriate to AI country. The overall goal of the ICCTC is to develop, refine, disseminate, and evaluate trauma-relevant intervention models and protocols for use with AI children. Currently, there are no well-supported or rigorously evaluated protocols designed specifically for native children with trauma-related disorders and problems. There are no known treatment approaches that are evidence-based and specifically designed for AI/AN children who experience trauma.
ICCTC has identified a set of empirically supported intervention models, and has built on the foundation of native traditional teachings and practices to develop training manuals for the three evidence-based approaches: 1) parent child interaction therapy; 2) cognitive-behavioral treatment for children with sexual behavior problems; and 3) trauma-focused cognitive behavioral therapy. Recent research has focused on strength-based interventions for AI/AN communities. The benefit of the three evidence-based approaches selected by ICCTC is that they can incorporate the strength-based concepts such as relationship building, cultural identity, and other values. The life skills development curriculum, which was developed specifically for ICCTC to build on the strength-based and life skills development of assertive and appropriate social interaction, is also being used.
ICCTC is using evidence-based models of treatment that are integrated with traditional native practices. Cultural appropriateness and competency are the foundation for the interventions. Addressing local or tribal beliefs or practices is critical because of the wide range of diversity among tribes. Modifications to the interventions explore the meaning of words and practices for treatment, recognizing that clinical treatment of trauma-related disorders may prove more sensitive.
Treatment of AI/AN children with mental health disorders is more than a shift in clinical approaches. Developing trauma-focused treatment for suicide and other tragedies involves focus on family trauma, family violence, community violence, and community readiness and healing. All therapeutic offerings should include a focus on family and community healing practices.
This article was contributed by Dolores Subia BigFoot, Ph.D., codirector of the Indian Country Child Trauma Center and assistant professor of pediatrics at the University of Oklahoma Health Sciences Center.
The Basic Crisis Counseling Grant Program Course was held August 14–17, 2006, at the Emergency Management Institute (EMI) in Emmitsburg, MD. The course was designed to prepare State mental health authorities (SMHAs) to apply for Federal Emergency Management Agency (FEMA) Crisis Counseling Assistance and Training Program (CCP) grant funding and to administer a program following major disasters. Representatives from 27 States and three U.S. Territories attended the training conducted by SAMHSA, FEMA, and SAMHSA Disaster Technical Assistance Center (DTAC) staff.
Prior to the training, attendees completed an online pretraining. The pretraining provided an introduction to disasters and to CCP. This served to familiarize attendees with disaster mental health so that more advanced topics could be presented at the full training course. On the first day of the training, a Jeopardy-style quiz was used as a fun way to review the material covered in the pretraining.
Topics presented in the full training included disasters and a CCP, assessing the need for a CCP, the Immediate Services Program (ISP), writing the ISP application, the Regular Services Program (RSP), evaluation, and closing down a CCP. It was decided early on that this training would be less didactic than trainings in the past. To achieve this goal, trainers facilitated numerous group activities and discussion sessions. A model disaster scenario featuring the fictional state of Minnark was used to allow attendees to work through the process of writing an ISP application for a developing disaster situation. Feedback from participants indicated that these activities were helpful and also encouraged networking between training attendees. On the last day of the training a final exam was administered. This exam not only provided information on how well the attendees learned the information presented, but also told trainers how well they completed their task of teaching the course. Final exam results were strong and the evaluations of the training completed by attendees were generally quite positive.
SAMHSA's Special Recognition Awards CeremonyAugust 1, 2006, Charles G. Curie, SAMHSA's outgoing Administrator took time to recognize SAMHSA employees for their commitment and dedication to their work. In his remarks, he praised everyone at SAMHSA for their commitment to the health, well-being, and recovery of people who are working to overcome a mental illness and the dedication to preventing addiction and promoting mental health. Of special note was SAMHSA's response to the 2005 hurricanes and the outstanding work of agency personnel who served as part of SAMHSA's Emergency Response Center. Mr. Curie also highlighted SAMHSA's accomplishments such as the President's Access to Recovery Initiative and the Strategic Prevention Framework. Mr. Curie asked all SAMHSA employees present at the ceremony to stand and be acknowledged for their contribution to the vision and mission of SAMHSA working to fulfill the promise of "A Life in the Community for Everyone." A plaque commemorating the event and honoring the employees is on display at SAMHSA headquarters in Rockville, MD. |
Recommended ReadingRESOURCES FOR CHILDREN AND FAMILIES
Electronic copies of this resource may be downloaded at http://www.nichd. nih.gov/publications/pubs_details.cfm?from=&pubs_id=286. Hardcopies may be ordered at no cost by calling 1-800-370-2943 and asking for publication number 03-5362B.
Spanish electronic copies may be downloaded at http://www.dhhs.state.nc.us/mhddsas/disasterpreparedness/pupsworld-total-spanish.pdf.
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Hurricanes Katrina and Rita revealed how vulnerable carless residents are in emergency situations. Evacuation plans
in most major cities across America fail to adequately take into account the needs of older adults, people with
disabilities, and transit-dependent populations. This conference, sponsored by the University of New Orleans
Transportation Center, the New Orleans Regional Planning Commission, and the Regional Transit Authority,
will bring together government officials, professionals, and experts to discuss how to better prepare to help those
who most need it. For more information, go to
Presented by the Emergency Medicine Learning and Resource Center (EMLRC), this conference
is designed to meet the educational needs of individuals and agencies involved with emergency
preparedness, response, and disaster recovery. Highlights include lessons learned
from recent disasters, disaster response strategies and tactics, medical and public health
disaster management, and terrorism response strategies and tactics. For more information, go
to
The American Counseling Association 2007 Annual Convention will include sessions
on substance abuse, grief work, and volunteering for major national disasters.
Preconvention learning institutes are scheduled for Wednesday and Thursday,
March 21 and 22 and education sessions will take place Friday through Sunday,
March 23–25. The exposition hall will be open Friday and Saturday,
March 23 and 24. For more information, go to
This conference will focus on all aspects of disaster recovery, contingency planning, and business continuity. Attendees will
gain knowledge and information through sessions, workshops, exercises, and networking opportunities. An exhibit hall will
showcase the latest products and services in the industry. For more information, go to
The American Psychological Association (APA) will cosponsor the Federal Office on Child Abuse and Neglect's 16th National Conference
on Child Abuse and Neglect. This meeting is the only national conference devoted to issues of child abuse and neglect and brings together
more than 2,000 practitioners, policy makers, community organizers, and researchers for a week of plenary, workshop, and skill-building
sessions. More information will be posted closer to the conference date at
The University of California, Los Angeles (UCLA) Center for Public Health and Disasters (CPHD) will host this multidisciplinary conference that brings together academicians,
researchers, practitioners, and policy makers from public health, mental health, community disaster preparedness and response, social
sciences, government, media, and nongovernmental organizations to address the public health consequences of natural and human-caused
disasters. For more information, go to
SAMHSA DTAC Launches Discussion BoardA new interactive communication tool is now available to disaster mental health coordinators, disaster substance abuse coordinators, Crisis Counseling Assistance and Training Program (CCP) directors and managers, and other disaster behavioral health professionals. SAMHSA DTAC designed the discussion board to generate discussion and facilitate knowledge transfer among those in the disaster behavioral health field. Two of the main forums are as follows:
A new forum on pandemic flu is the latest addition to the topics for
discussion. If you would like to join the discussion board, or you would
like to suggest one of your colleagues for inclusion, please send an
e-mail with a brief justification to If you already belong to the discussion board, please visit it often to post your resources and questions. For technical issues or to suggest
a new forum area for posting, please contact Leisel Bucheit, SAMHSA DTAC information systems manager, at We hope that you find this new tool useful, and we look forward to your participation! |
CALL FOR INFORMATION The Dialogue is an arena for professionals in the disaster behavioral health field to share information, resources,
trends, solutions to problems, and accomplishments. Readers are invited to contribute profiles of successful programs, book reviews, highlights
of State and regional trainings, and other news items. If you are interested in submitting information, please contact Kathleen Wood
at |
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AN ACTIVITY BOOK FOR AFRICAN AMERICAN FAMILIES:
HELPING CHILDREN COPE WITH CRISIS
WELCOME TO PUP'S WORLD!
HOW ARE WE NOW? PROMOTING CONTINUED HEALING FOR OUR CHILDREN