This essay addresses how the definitions of disaster and vulnerability serve as guides for market and policy responses and shows how a fundamental lack of understanding of what creates a disaster and what constitutes human (and consumer) vulnerability constrains the ability of individuals, communities, and institutions to mitigate and/or recover from natural hazards and the responses that follow. The essay outlines the current state of affairs on conceptualizations of disaster and vulnerability, distinguishes between risk and vulnerability, and notes ten paradoxes of disaster that create constraints on resilience. Fundamentally, the perspective taken here is that disaster is socially constructed and that vulnerability is a dynamic process that depends on a host of contextual factors. The essay shows that sustainable models of economic, social, and environmental development are at the heart of disaster and vulnerability analysis. Furthermore, it argues that market and policy responses must conside...

/pdf/vulnerability-and-resilience-in-natural-disasters-a-1xlsoul9qm.pdf

Vulnerability and Resilience in Natural Disasters: A Marketing and Public Policy Perspective:

BACKGROUND: Little is known about how to remedy the unmet mental health needs associated with major terrorist attacks, or what outcomes are achievable with evidence-based treatment. This article reports the usage, diagnoses and outcomes associated with the 2-year Trauma Response Programme (TRP) for those affected by the 2005 London bombings. Method: Following a systematic and coordinated programme of outreach, the contact details of 910 people were obtained by the TRP. Of these, 596 completed a screening instrument that included the Trauma Screening Questionnaire (TSQ) and items assessing other negative responses. Those scoring 6 on the TSQ, or endorsing other negative responses, received a detailed clinical assessment. Individuals judged to need treatment (n=217) received trauma-focused cognitive-behaviour therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Symptom levels were assessed pre- and post-treatment with validated self-report measures of post-traumatic stress disorder (PTSD) and depression, and 66 were followed up at 1 year. RESULTS: Case finding relied primarily on outreach rather than standard referral pathways such as primary care. The effect sizes achieved for treatment of DSM-IV PTSD exceeded those usually found in randomized controlled trials (RCTs) and gains were well maintained an average of 1 year later. CONCLUSIONS: Outreach with screening, linked to the provision of evidence-based treatment, seems to be a viable method of identifying and meeting mental health needs following a terrorist attack. Given the failure of normal care pathways, it is a potentially important approach that merits further evaluation. Language: en

http://www.emdr.dk/Admin/Public/Download.aspx?file=Files%2fFiles%2fArtikler%2f10_Brewin-2010.pdf

Outreach and screening following the 2005 London bombings: usage and outcomes

Social workers are called to respond to disasters to provide assessment, crisis counseling and trauma treatment as part of the recovery effort. While research has identified the types of interventions appropriate in assisting trauma survivors, little empirical research exists to help address the distress responses that social workers experience when exposed to the trauma material of disaster survivors and their families. Case examples can inform social work practice using evidence informed interventions and recording the outcomes. This article presents three case histories of social workers responding to disasters, the course of their secondary traumatic stress responses and their struggle to overcome the psychological adversity they faced.

/pdf/secondary-traumatic-stress-in-social-workers-responding-to-37fd2ybje6.pdf

Secondary Traumatic Stress in Social Workers Responding to Disasters: Reports from the Field

Research has shown that compassion fatigue is associated with burnout and compassion satisfaction. Practically no studies have examined how resilience may impact these variables. This study examined how resilience is related to compassion fatigue, burnout, and compassion satisfaction among a convenience sample of disaster behavioral health and emergency preparedness responders (N =139) attending a training conference in Michigan. Measures included the 30-item Professional Quality of Life Scale, the 14-item Resilience Scale, and a demographic questionnaire. Seventy-two percent of the participants were at risk for compassion fatigue, while 19% were at risk for burnout. Only 22% of participants had scores indicative of high resilience. Resilience was found to have a significant negatively correlation with compassion fatigue and with burnout. A significant positive correlation was also found between compassion satisfaction and resilience. Mediation analysis found that resilience moderately mediated the relationship between compassion fatigue and burnout. These findings suggest that resilience plays an important role in mediating the effects between compassion fatigue and burnout. Implications for practice are discussed.

/pdf/the-compassion-fatigue-and-resilience-connection-a-survey-of-39p19vmqzd.pdf

The Compassion Fatigue and Resilience Connection: A Survey of Resilience, Compassion Fatigue, Burnout, and Compassion Satisfaction among Trauma Responders

When a disaster strikes, parents are quick to seek out the medical advice and reassurance of their primary care physician, pediatrician, or in the case of an emergency, an emergency department physician. As physicians often are the first line of responders following a disaster, it is important that they have a thorough understanding of children's responses to trauma and disaster and of recommended practices for screening and intervention. In collaboration with mental health professionals, the needs of children and families can be addressed. Policy-makers and systems of care hold great responsibility for resource allocation, and also are well-placed to understand the impact of trauma and disaster on children and children's unique needs in such situations.

When Disaster Strikes: Responding to the Needs of Children

The traditional medical roles of doctor and patient are not particularly well suited to disaster scenarios for reasons to be discussed later. Certain federal, state and local medical entities provide disaster mental health services along medical occupational lines, I.e., social workers, psychologists and psychiatrists. These degreebased distinctions have little practical value at a disaster site with the exception of a rare individual who might require psychiatric medication. My personal experience has been as a member of a Disaster Medical Assistance Team (DMAT), a unit of the National Disaster Medical System (US Public Health Service) as well as a disaster mental health volunteer with the American Red Cross. The American Red Cross, the official lead disaster relief agency in the U.S., utilizes a different (non-medical) model of mental health services. All state licensed mental health professionals are considered as (generic) mental health workers, with no distinction, for example, between psychiatrists and (licensed) counselors. Regardless of which occupational training the mental health professional received, there typically is little, if any, formal graduate school training for activities at a disaster site. Therefore the American Red Cross requires all professional applicants for volunteer disaster mental health work to undergo 16 hours of course work. Classes include, but are not limited to: the emotional impact of disaster, roles of direct services, and defusing and debriefing. Attendees get some “hands-on” experience by role-playing various disaster scenarios. Clearly, regardless of professional designation, the victims will receive identical services from any and all Red Cross disaster mental health workers. (1) In the Red Cross organization, top priority for mental health services is to Red Cross volunteers as well as other disaster responders. The premise being that unless responders function well, the relief operation may be compromised. The second priority is providing services to victims (referred to as clients) and their families. In a medical model, victims would be referred to as “patients, “ as least semantically indicating that they have become “sick.” Both the Red Cross as well as the US Armed Forces considers persons who are severely stressed as having NORMAL reactions to abnormal situations. Only individuals who develop significant mental symptoms are deemed to be mentally ill. Contrary to the role of traditional mental health workers, within the Red Cross there are numerous functions they perform in addition to the customary mental health diagnostic and therapeutic activities. Stress management is probably the single most important function. Training in stress prevention/reduction is offered to other Red Cross volunteers and takes place in local Red Cross chapters. At a disaster site, mental health workers serve as “stress troubleshooters,” and monitor all activities and interactions that might be stressful. For example, noticing that workers are becoming irritable due to long shifts would be brought to the attention of the supervisory staff. Supervisor-staff conflicts would be mediated by a mental health worker. Of course, formal mental health symptoms would be noted, evaluated, and appropriate referrals made. At the conclusion of an especially stressful episode or day, debriefing would take place, conducted by mental health workers trained in that activity. Furthermore, all Red Cross volunteers are expected to be debriefed at the conclusion of their assignments. Additional functions of Red Cross mental health personnel include (2): Disaster Mental Health Services 2 of 3 Participating in staff meetings Assisting with the work of other functions Advocating improvement of mental health conditions within the setting Provide consultation within and across functions Assessing stress level of supervisors and providing interventions appropriately Of secondary priority are mental health interventions for clients (victims) and their families, including support during their grieving as well as amelioration of other stresses due to loss of property, etc.. Debriefing is done when appropriate and referral to local mental health resources is performed. At the recent Egypt Air crash site, about 50 Red Cross mental health workers (including the author) were deployed. Assignments included assistance to grieving families as well as mental health support for all Red Cross volunteers and other responders, such as the FBI. In contrast, at Ft. Dix, New Jersey, where up to 4000 Kosovo refugees were processed, only one nurse with some mental health experience was available. Actually, she was assigned to more pressing medical duties. Many refugees had been raped and had other horrendous experiences, requiring interventions, debriefing, etc. Yet when the author volunteered, he was told that no psychiatrists were needed, since several Public Health Service psychiatrists were on the scene to perform forensic immigration related evaluations. Apparently psychiatrists were not deemed relevant to performing ’counseling” or other direct services to the refugees. An example of the limitation of strictly utilizing the traditional medical model of services and thereby not seeing the forest through the trees! Red Cross mental health workers at a disaster site are adequately supervised to avoid intrusive or unwanted interventions or ethical lapses such as soliciting private clients. The latter is more likely to occur when local nonRed Cross mental health volunteers appear at a disaster site.

/pdf/disaster-mental-health-services-4em58ro0re.pdf

Eric H. Marcus

Papers

Disaster Mental Health Services