Mental Health Responders for Crisis, Trauma, and Disaster Events Critical incident responders come from a variety of fields. Rescue workers (e.g., police, firefighters, emergency med

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Clin Soc Work J (2017) 45:99–101 DOI 10.1007/s10615-017-0623-8

EDITORIAL

The Role of Social Work in the Aftermath of Disasters and Traumatic Events

Jennifer Bauwens1 · April Naturale2 

Published online: 27 April 2017 © Springer Science+Business Media New York 2017

Importantly, social workers have the potential to bring a unique understanding to the disaster field by underscor- ing the values of our profession and giving attention to oppressed and disadvantaged populations. This perspective is vital for the development of individual, family, and com- munity response plans. Additionally, the social work per- spective is needed for conducting research after a disaster or traumatic event. In other words, the social work profes- sion needs to have a voice in a budding field that is lacking, but developing, interventions, research, and empirical evi- dence to guide our disaster-related responses.

Given the increase in all types of communal disasters, it’s no surprise that other disciplines have also acknowl- edged the need to firm up our concepts and theories, response plans and interventions, and to solidify, best prac- tices and evidence-based responses at the micro to macro levels. In an effort to provide greater conceptual clarity for the experiences of disaster survivors, psychologists from the National Center for Posttraumatic Stress Disorder took a first step and defined a disaster as, “a sudden event that has the potential to terrify, horrify or engender substantial losses for many people simultaneously” (Norris 2002, p. 1). This definition was later expanded to identify the type of disaster as natural or weather related, human caused  acci- dents (i.e., technological), intentionally caused (i.e., ter- rorism and mass violence), and armed conflict/war (IFRC 2016; SAMHSA 2016).

Defining a “disaster” was an essential first step, as this concept outlined a necessary distinction between different types of disasters. This distinction is important because it incorporates the evidence which suggests that there is, indeed, a difference in the traumatic responses that accom- pany the nature of a disaster (e.g., Norris et  al. 2002). Further, our current definition has helped shape how we approach and develop interventions, response plans, and

Over the past 15 years, in the United States, there has been an estimated 40% increase in federally declared disasters (FEMA 2016a, b). These numbers are even higher on the international scene, where natural disasters have doubled over the past two decades (IFRCRC 2016; Holmes 2008). Global armed conflict has been on the rise (IRC 2015), and has resulted in an increase in traumatic exposure and expe- riences for civilians and soldiers alike. The rise in armed conflict has been equated with an increase in refugees, with some estimates counting a million individuals and families that have been affected (IFRCRC 2016; IRC 2016). For many refugees, there seems to be no imminent resolution in sight, particularly for those coming from the Middle East.

With a growing number of people facing traumatic events, it is important, as a profession, we are clear about the role social workers have in the disaster planning, response, and recovery phases. In fact, social work, as a profession, has already played an important role in the dis- aster field, as many are informed, trained, and experienced in the basic skills necessary to respond. This is evidenced by the fact that nearly half of the disaster mental health services, in the U.S., have been delivered by social work- ers who are affiliated with the American Red Cross and the Federal Crisis Counseling Assistance and Training pro- grams (ARC 2016; FEMA 2016a, b).

* Jennifer Bauwens [email protected]

April Naturale [email protected]

1 Rutgers, the State University of New Jersey, 536 George Street, New Brunswick, NJ 08901, USA

2 New York University, Silver School of Social Work, 1 Washington Square N, New York, NY 10003, USA

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conduct research to advance the field. As the definition of disaster dictates, a one-size-fits-all intervention plan may not always be appropriate. Interventions, then, need to be implemented with consideration to the type of disaster, but also with attention to the phase in which the interven- tions will be delivered (i.e., acute, long-term ), the geo- graphic area(s) affected by the event (i.e., block, city, state), the scope (i.e., number of people killed, injured, the level of destruction), and other known risk factors for negative social and psychological sequelae post-disaster (i.e., trauma and psychiatric history).

Taken together, this means the skills and knowledge required to respond to disasters, of all types, are vastly different than traditional clinical skills, psychotherapy, or trauma treatment. For example, contacts with disaster sur- vivors, particularly immediately after an event, are gener- ally held at a Family Assistance Center or another com- munity or faith based location.  Meetings are often time limited (i.e., sometimes as little as one session). In this case, the goal is symptom reduction, psychoeducation, and providing resources and referrals.  This is vastly different than a first session characteristic of most types of clini- cal work.  That is, with traditional trauma-focused clinical modalities, the focus of an initial session is likely to be on establishing trust in effort to promote disclosure of an ear- lier traumatic experience. Regardless if the clinical model is long- or short-term, the goal, in part, is for the client to share their trauma narrative, but with greater detail than is afforded in disaster work.

Disaster practices, on the other hand, can be further dif- ferentiated from clinical work by the tendency to necessar- ily intervene immediately or shortly after the disaster or traumatic event.  Aside from the obvious, another reason for disaster interventions to primarily focus on the short- term may be related to the developmental phase of the field, which is in the infancy stage. For this reason, the field has a lot of unanswered questions and unaddressed areas that require further investigation. For example, it is clear, as we are learning from the Oklahoma City bombing and the events of September 11, 2001, that complications may develop over the long-term (e.g., Neria et al. 2007). None- theless, research and response plans have focused primar- ily on the most pressing issues, in this case, the immediate needs of survivors.

Again, by comparison, advances have been made toward building a solid base of evidence to support many trauma- focused interventions (e.g., NCPTSD 2016). This is not the case, however, when it comes to disaster response prac- tices. Routinely used practices such as, psychological first aid, crisis intervention and counseling, critical incident stress debriefing, mental health media communications, family care, resilience and community capacity build- ing, and many other support activities, play a vital role in

a comprehensive disaster mental health response program. These practices are employed with minimal research to inform their use.

Another reason for the lack of evidence to support regu- larly used disaster mental health practices rests in the fact that this type of research can be difficult to conduct. Some may even consider it controversial or inappropriate to ask trauma survivors, family members, and responders to par- ticipate in a study amid their emotional distress, loss, and grief. Additionally, there might be challenges to conducting the research itself. In most instances, researchers conduct- ing clinical studies have access to a clinic, hospital, or non- profit organization. For disaster researchers, there may not be a formal gatekeeper to help connect the scientific com- munity to affected responders, individuals, and families to involve them in study. For now, and until research findings are strengthened in the disaster field, social workers and clinicians can glean from theory, expert consensus, white papers, and anecdotal reports to inform their interventions. In this case, these sources provide the best evidence avail- able to determine the most effective intervention given the current state of the field. As a starting point, the criterion for selecting an intervention is simply one that promises to do “no harm.”

The purpose, then, of this special issue is to inform social workers and clinicians concerning a wide-range of topics associated with the social and psychological affects that follow different types of disasters. Some of the articles included in this issue will contribute theory, case study, anecdotal and empirical evidence, and introduce new con- cepts and interventions pertinent to the disaster discourse. The areas covered in this issue focus on developing com- munity resilience, the presence of domestic violence after a large-scale traumatic event, a narrative from a disaster researcher who survived a house fire, and a review of the qualitative literature on the long-term effects of families who lost a loved one following September 11, 2001. This issue is also aimed at bringing the reader up-to-date with the latest advances and thought surrounding micro and macro interventions, for children, schools, and communi- ties. These articles discuss educating students about disas- ter response, how to develop a cadre of university student responders, supporting children who are high risk after a traumatic event, a case review of lessons learned from a program applied to the Boston Marathon bombing (Natu- rale et  al. 2017), and a framework for enhancing commu- nity resilience. These papers, although varied, highlight the uniqueness of the disaster field. Every article included in this issue is expected to help social workers and other professionals to be aware of the multi-faceted issues facing those who respond, and those who will respond, to do so effectively and appropriately in the unfortunate, but inevita- ble, event of a disaster.

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References

American Red Cross. (2016). Retrieved November 4, 2016 from http:// www.redcross.org/about-us/history/global-red-cross-network.

Federal Emergency Management Agency. (2016a). Retrieved Novem- ber 17, 2016 from https://www.fema.gov/disasters/grid/year.

Federal Emergency Management Agency. (2016b). Crisis Counseling Assistance and Training Program. Retrieved from: https://www. fema.gov/media-library-data/1465330831840-a8641fe39cbaad- 835f9ba670d082c1d9/FACT_SHEETCrisis_Counseling_Pro- gram2016.pdf.

Holmes, J. (2008). More help now please: How to tackle tomorrow’s disasters. The Economist, 110.

International Federation of Red Cross. (2016). Types of disas- ters: Definition of hazard. Retrieved November 17, 2016 from http://www.ifrc.org/en/what-we-do/disaster-management/ about-disasters/definition-of-hazard/.

International Federation of Red Cross and Red Crescent Societies. (2016). World Disasters Report. Retrieved from http://ifrc- media.org/interactive/wp-content/uploads/2015/09/1293600- World-Disasters-Report-2015_en.pdf and http://www.ifrc.org/.

International Rescue Committee. (2015). Annual Report. Retrieved from http://feature.rescue.org/annual-report-2015/.

International Rescue Committee. (2016). Retrieved November 16, 2016 from https://www.rescue.org/topic/refuge-america?gclid =Cj0KEQiA08rBBRDUn4qproqwzYMBEiQAqpzns0oT23M- Vln8-8VqBiPw_rKlhUorLGZ0mjje0Knto9VsaAtiw8P8HAQ.

National Center for Posttraumatic Stress Disoder. (2016). Retrieved November 17, 2016 from http://www.ptsd.va.gov/professional/ trauma/disaster-terrorism/index.asp.

Naturale, A., Lowney, L. T., & Brito, C. S. (2017). Lessons learned from the Boston Marathon bombing victim services pro- gram. Clinical Social Work Journal, 45(2). doi:10.1007/ s10615-017-0624-7

Neria, Y., Gross, R., Litz, B., Maguen, S., Insel, B., Seirmarco, G., et  al. (2007). Prevalence and psychological correlates of com- plicated grief among bereaved adults 2.5–3.5  years after Sep- tember 11th attacks. Journal of Traumatic Stress, 20, 251–262. doi:10.1002/jts.20223.

Norris, F. (2002). Psychosocial consequences of disaster. PTSD Quar- terly, 13(2), 1–3.

Norris, F. H., Friedman, M. J., Watson, P. J., Byrne, C. M., Diaz, E., & Kaniasty, K. (2002). 60,000 disaster victims speak: An empir- ical review of the empirical literature, 1981–2001. Psychiatry, 65, 207–239. doi:10.1521/psyc.65.3.207.20173.

Substance Abuse and Mental Health Services Administration. (2016). Crisis Counseling Assistance and Training Program Core Con- tent Training. Retrieved from http://www.samhsa.gov/dtac/ ccp-toolkit/train-your-ccp-staff/core-content-training.

Jennifer Bauwens Ph.D., LCSW has worked, both nationally and internationally, with children and adult survivors of disasters, abuse, and other traumatic events. She currently consults with nonprofits to develop evaluation tools and trauma-informed curriculums and train- ings, and she teaches courses on research and trauma at Rutgers, The State University of New Jersey.

April Naturale Ph.D., is a trauma specialist at ICF and architect of the marathon bombing behavioral health response. She directed the mental health response to 9/11 in NY.

Clinical Social Work Journal is a copyright of Springer, 2017. All Rights Reserved.

Community Disasters, Psychological Trauma, and Crisis Intervention

Joseph A. Boscarino, PhD, MPH1,2,3

1Center for Health Research, Geisinger Clinic, Danville, PA, USA

2Department of Psychiatry, Temple University School of Medicine, Philadelphia, PA, USA

3Departments of Medicine & Pediatrics, Mount Sinai School of Medicine, New York, USA

Abstract

The current issue of International Journal of Emergency Mental Health and Human Resilience is

focused on community disasters, the impact of trauma exposure, and crisis intervention. The

articles incorporated include studies ranging from the World Trade Center disaster to Hurricane

Sandy. These studies are related to public attitudes and beliefs about disease outbreaks, the impact

of volunteerism following the World Trade Center attacks, alcohol misuse among police officers

after Hurricane Katrina, posttraumatic stress disorder after Hurricane Sandy among those exposed

to the Trade Center disaster, compassion fatigue and burnout among trauma workers, crisis

interventions in Eastern Europe, and police officers' use of stress intervention services. While this

scope is broad, it reflects the knowledge that has emerged since the Buffalo Creek and Chernobyl

catastrophes, to the more recent Hurricane Katrina and Sandy disasters. Given the current threat

environment, psychologists, social workers, and other providers need to be aware of these

developments and be prepared to mitigate the impact of psychological trauma following

community disasters, whether natural or man-made.

Keywords

Disasters; psychological trauma; crisis intervention; public health

Disasters are typically classified into several distinct categories, including: natural disasters

and major disease outbreaks; mass violence and human-made disasters; and technological

disasters (Neria, Galea, & Norris, 2009). All three of these disaster types have both unique

and common elements that affect the impact of exposure to these events. The most common

adverse outcomes observed among people following these exposures include the onset of

mental health and physical health problems, substance misuse, and increased mental health

service utilization (Neria et al., 2009). Nevertheless, the most common health outcome

observed is positive: following disasters most persons are generally resilient and manifest

few or no long-term adverse health outcomes, a finding consistently documented in

numerous studies (Bonanno, 2004; Boscarino & Adams, 2009; Pietrzak et al., 2014). What

predicts this psychological resistance? One of the major factors is the availability of

*Correspondence regarding this article should be directed to: [email protected]

HHS Public Access Author manuscript Int J Emerg Ment Health. Author manuscript; available in PMC 2015 May 13.

Published in final edited form as: Int J Emerg Ment Health. 2015 ; 17(1): 369–371.

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psychosocial resources (Adams & Boscarino, 2006; Adams, Boscarino, & Galea, 2006).

Another is the absence of preexisting vulnerabilities, including preexisting mental health

disorders and genetic risk factors (Boscarino & Adams, 2009; Boscarino, Erlich, Hoffman,

& Zhang, 2012). Of course, the level of trauma exposure is a major risk factor in the onset of

psychopathology and the absence or low level of the latter is protective (Boscarino, Adams,

& Figley, 2004; Boscarino & Adams, 2008). In addition, and perhaps most importantly,

early brief psychosocial interventions appear to be effective in the reduction and/ or

mitigation of adverse health consequences (Boscarino, Adams, & Figley, 2011). It is noted

that while our World Trade Center Disaster (WTCD) research, funded by the National

Institute of Mental Health (Grant # R01-MH-066403 and R21-MH-086317), was a source of

many findings (Boscarino & Adams, 2008), the modern disaster research literature goes

back at least several decades (Bromet & Dew, 1995; Freedy, Kilpatrick, & Resnick, 1993;

Gleser, Green, & Winget, 1981; Rubonis & Bickman, 1991). Our recent WTCD report

related to police officers and Hurricane Sandy research was built upon this preexisting body

of research (Adams & Boscarino, 2011; Boscarino, Hoffman, Adams, Figley, & Solhkhah,

2014).

Scope of Disaster Research

The current issue of the International Journal of Emergency Mental Health and Human

Resilience includes an overview of research approaches to assess the impact of different

disasters and the importance of developing crisis interventions (Boscarino and Adams,

Assessing Community Reactions to Ebola Virus Disease and Other Disasters, pp. 234-238).

This is followed by a study of alcohol misuse among law enforcement officers following

Hurricane Katrina (Heavey et al., Law Enforcement Offcers' Involvement Level in

Hurricane Katrina and Alcohol Use, pp. 267-273). Next is a study related to the impact of

volunteerism following the World Trade Center disaster in New York City (Adams and

Boscarino, Volunteerism and Well-Being in the Context of the World Trade Center Terrorist

Attacks, pp. 274-282). This study is followed by a report related to police officers' use of

stress intervention services in Pennsylvania (Tucker, Police Officer Willingness to Use

Stress Intervention Services, pp. 304-314). Next is a study on the subject of “compassion

fatigue” (Burnett and Wahl, The Compassion Fatigue and Resilience Connection, pp.

318-326), an increasingly important area of research related to adverse health outcomes

among disaster responders (Adams, Figley, & Boscarino, 2008). Next, is research related to

the impact of Hurricane Sandy among those exposed to the World Trade Center disaster

(Caramanica et al., Posttraumatic Stress Disorder after Hurricane Sandy among Persons

Exposed to the 9/11 Disaster, pp. 356-362), a case report related to developing a foundation

for crisis intervention in eastern Europe (Parks, Building a Foundation for Crisis

Intervention in Eastern Europe, pp. 352-355), and an editorial on disaster mental health

(Mazumder, Disaster Mental Health and Crisis Interventions, pp. 368). Thus, the scope of

studies covered in this issue includes a wide range of disasters and psychological trauma

exposures and a number of different health outcomes.

Over the past decade, to examine the social and psychological aspects of the terrorist attacks

in New York, we studied more than several thousand adult residents and mental health

professionals (Adams, Boscarino, & Figley, 2006; Adams, Laraque, Chemtob, Jensen, &

Boscarino Page 2

Int J Emerg Ment Health. Author manuscript; available in PMC 2015 May 13.

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Boscarino, 2013; Boscarino, Figley, & Adams, 2003; Boscarino et al., 2004; Boscarino,

Adams, Stuber, & Galea, 2005; Boscarino, Adams, Figley, Galea, & Foa, 2006). This body

of research has revealed key risk and protective factors associated with poorer health

outcomes. As suggested in our community reaction paper in this issue (Boscarino and

Adams, pp. 234-238), our disaster research findings are generally consistent with terror

management theory, which suggests that a key to understanding peoples' reactions to serious

environmental threats is understanding the fear of death (Pyszczynski, Greenberg, &

Solomon, 1999; Strachan et al., 2007). Similar to stress-process theory (Adams &

Boscarino, 2005; Boscarino et al., 2014), this human fear response is affected by social

factors, self-esteem, and social support — factors responsible for buffering individuals

against traumatic episodes and the subsequent adverse cognitive processes associated with

these event exposures (Pyszczynski et al., 1999; Strachan et al., 2007).

Given the threat to public health, community interventions should be a post-disaster priority,

including community surveys, workplace education programs, and public service

announcements (Engel Jr & Katon, 1999; Foa et al., 2005), as well as provider-focused

interventions (Adams et al., 2013; Gershon et al., 2004). Post-event health surveillance also

should be planned in the aftermath of a major disaster or disease outbreak (Engel Jr &

Katon, 1999; Foa et al., 2005). It has been suggested that public education and

communication can reduce or limit adverse population reactions (Covello et al., 2001; Foa et

al., 2005). It has been noted that “risk communication” can have the effect of both reducing

fear and also promoting self-protecting behaviors, thus preventing misinformation (Covello

et al., 2001; Foa et al., 2005). Without these efforts, vulnerable persons and groups may

increase the level of social disruption in the community (Boscarino et al., 2003; Boscarino et

al., 2006). As we discuss below, the nature of major disasters make media coverage and

communications critical, warranting special planning considerations (Foa et al., 2005; North

& Pfefferbaum, 2002). As we have suggested elsewhere, our WTC disaster study indicated

that simple, worksite crisis interventions offered by local employers immediately after the

WTC attacks were effective in reducing a number of mental health problems post-disaster,

including a significant reduction in anxiety symptoms (Boscarino et al., 2011).

Research Approach

Much of the recent disaster research has been based on surveys of adults in the affected

disaster areas (Adams & Boscarino, 2006; Boscarino et al., 2004; Boscarino et al., 2006;

Galea et al., 2002). Another major category of research includes studies of trauma workers,

healthcare personnel, and first responders (Adams et al., 2008; Adams et al., 2013; Gershon

et al., 2004). One of the limitations of these surveys is the cost, however, since these studies

are expensive to conduct (Groves et al., 2009). Consequently, other methods for data

collection are used, such as focus groups and on-line internet surveys (Groves et al., 2009).

The other chief methodology used in public health disaster research is the post-disaster

research registry (Jordan, Miller-Archie, Cone, Morabia, & Stellman, 2011). One of the

more well known of these, is the World Trade Center Disaster Registry (Institute of

Medicine and US Department of Health and Human Services, 2014; Jordan et al., 2011). An

example of disaster research using this approach is included in this curre

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