Susan P. Stevens

Bio: Susan P. Stevens is an academic researcher from Dartmouth College. The author has contributed to research in topics: Community resilience & Population. The author has an hindex of 6, co-authored 9 publications receiving 4087 citations. Previous affiliations of Susan P. Stevens include United States Department of Veterans Affairs & Veterans Health Administration.

Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness

Abstract: Communities have the potential to function effectively and adapt successfully in the aftermath of disasters. Drawing upon literatures in several disciplines, we present a theory of resilience that encompasses contemporary understandings of stress, adaptation, wellness, and resource dynamics. Community resilience is a process linking a network of adaptive capacities (resources with dynamic attributes) to adaptation after a disturbance or adversity. Community adaptation is manifest in population wellness, defined as high and non-disparate levels of mental and behavioral health, functioning, and quality of life. Community resilience emerges from four primary sets of adaptive capacities—Economic Development, Social Capital, Information and Communication, and Community Competence—that together provide a strategy for disaster readiness. To build collective resilience, communities must reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, and plan for not having a plan, which requires flexibility, decision-making skills, and trusted sources of information that function in the face of unknowns.

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.

Abstract: Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population.

Community Resilience and the Principles of Mass Trauma Intervention

Abstract: Drawing upon literatures in several disciplines, Norris and colleagues (in press) concluded that the resilience of communities, and consequently the wellness of communities, rests upon a network of adaptive capacities, particularly Economic Development, Social Capital, Information and Communication, and Community Competence. There are numerous ways in which efforts to build community resilience might also achieve the five essential elements of mass trauma intervention explicated by Hobfoll and colleagues. Thus, it is argued here that efforts to reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, cultivate trusted and responsible information resources, and enhance decision–making skills will augment more specific intervention efforts to promote safety, calming, efficacy, hope, and connectedness in the aftermath of mass trauma. Many of these outcomes require systems and social changes that can be the target of in...

Commentary on "Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence" by Hobfoll, Watson et al. Community Resilience and the Principles of Mass Trauma Intervention

Abstract: Drawing upon literatures in several disciplines, Norris and colleagues (in press) concluded that the resilience of communities, and consequently the wellness of communities, rests upon a network of adaptive capacities, particularly Economic Development, Social Capital, Information and Communication, and Community Competence. There are numerous ways in which efforts to build community resilience might also achieve the five essential elements of mass trauma intervention explicated by Hobfoll and colleagues. Thus, it is argued here that efforts to reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, cultivate trusted and responsible information resources, and enhance decision–making skills will augment more specific intervention efforts to promote safety, calming, efficacy, hope, and connectedness in the aftermath of mass trauma. Many of these outcomes require systems and social changes that can be the target of intervention efforts before as well as after disasters.

Cognitive-behavioral conjoint therapy for PTSD: pilot results from a community sample.

Abstract: Many individuals with posttraumatic stress disorder (PTSD) experience problems in their intimate relationships; there also is evidence that family dysfunction is associated with poorer individual treatment outcomes (see Monson, Fredman, & Dekel, 2010). As a result, clinicians and researchers alike have called for the development and testing of couple/family-based treatments for patients with PTSD and their loved ones (Riggs, Monson, Glynn, & Canterino, 2009). There is only one published randomized trial of conjoint therapy for PTSD. Glynn and colleagues (1999) found that veterans receiving behavioral family therapy after individual exposure treatment had statistically significant improvements in interpersonal problem solving compared with veterans who received individual exposure only. Although not statistically significant, improvements in positive symptoms of PTSD (i.e., reexperiencing, hyperarousal) in the combined condition were approximately twice that obtained in the exposure-only condition. Uncontrolled trials of other types of conjoint therapy have found improvements in overall PTSD symptoms and relationship adjustment (e.g., MacIntosh & Johnson, 2008) and avoidance symptoms (Sautter, Glynn, Thompson, Franklin, & Han, 2009), whereas others have found improvements in relationship satisfaction only and not PTSD symptoms (e.g., Rabin & Nardi, 1991). Cognitive–behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, in press) was designed to decrease PTSD symptoms and improve relationship adjustment. A prior uncontrolled study of CBCT for PTSD with male Vietnam combat veterans and their wives found pre- to posttreatment improvements in veterans’ symptoms of PTSD and its comorbidities, wives’ relationship satisfaction, and wives’ mental health functioning (Monson, Schnurr, Stevens, & Guthrie, 2004; Monson, Stevens, & Schnurr, 2005). The overall goal of the current uncontrolled study was to test a revised version of the therapy in a sample that varied in the gender of the identified patient, type of trauma, and sexual orientation of the partners. The primary hypotheses were that CBCT for PTSD would be associated with significant improvements in the PTSD-identified partners’ PTSD symptoms and the couples’ relationship adjustment across treatment. Secondary hypotheses were that the treatment would be associated with improvements in comorbid conditions in both partners.

A place-based model for understanding community resilience to natural disasters

Abstract: There is considerable research interest on the meaning and measurement of resilience from a variety of research perspectives including those from the hazards/disasters and global change communities. The identification of standards and metrics for measuring disaster resilience is one of the challenges faced by local, state, and federal agencies, especially in the United States. This paper provides a new framework, the disaster resilience of place (DROP) model, designed to improve comparative assessments of disaster resilience at the local or community level. A candidate set of variables for implementing the model are also presented as a first step towards its implementation.

Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war.

Abstract: ContextTo promote early identification of mental health problems among combat veterans, the Department of Defense initiated population-wide screening at 2 time points, immediately on return from deployment and 3 to 6 months later. A previous article focusing only on the initial screening is likely to have underestimated the mental health burden.ObjectiveTo measure the mental health needs among soldiers returning from Iraq and the association of screening with mental health care utilization.Design, Setting, and ParticipantsPopulation-based, longitudinal descriptive study of the initial large cohort of 88 235 US soldiers returning from Iraq who completed both a Post-Deployment Health Assessment (PDHA) and a Post-Deployment Health Re-Assessment (PDHRA) with a median of 6 months between the 2 assessments.Main Outcome MeasuresScreening positive for posttraumatic stress disorder (PTSD), major depression, alcohol misuse, or other mental health problems; referral and use of mental health services.ResultsSoldiers reported more mental health concerns and were referred at significantly higher rates from the PDHRA than from the PDHA. Based on the combined screening, clinicians identified 20.3% of active and 42.4% of reserve component soldiers as requiring mental health treatment. Concerns about interpersonal conflict increased 4-fold. Soldiers frequently reported alcohol concerns, yet very few were referred to alcohol treatment. Most soldiers who used mental health services had not been referred, even though the majority accessed care within 30 days following the screening. Although soldiers were much more likely to report PTSD symptoms on the PDHRA than on the PDHA, 49% to 59% of those who had PTSD symptoms identified on the PDHA improved by the time they took the PDHRA. There was no direct relationship of referral or treatment with symptom improvement.ConclusionsRescreening soldiers several months after their return from Iraq identified a large cohort missed on initial screening. The large clinical burden recently reported among veterans presenting to Veterans Affairs facilities seems to exist within months of returning home, highlighting the need to enhance military mental health care during this period. Increased relationship problems underscore shortcomings in services for family members. Reserve component soldiers who had returned to civilian status were referred at higher rates on the PDHRA, which could reflect their concerns about their ongoing health coverage. Lack of confidentiality may deter soldiers with alcohol problems from accessing treatment. In the context of an overburdened system of care, the effectiveness of population mental health screening was difficult to ascertain.

Resilience definitions, theory, and challenges: interdisciplinary perspectives

Abstract: In this paper, inspired by the plenary panel at the 2013 meeting of the International Society for Traumatic Stress Studies, Dr. Steven Southwick (chair) and multidisciplinary panelists Drs. George Bonanno, Ann Masten, Catherine Panter-Brick, and Rachel Yehuda tackle some of the most pressing current questions in the field of resilience research including: (1) how do we define resilience, (2) what are the most important determinants of resilience, (3) how are new technologies informing the science of resilience, and (4) what are the most effective ways to enhance resilience? These multidisciplinary experts provide insight into these difficult questions, and although each of the panelists had a slightly different definition of resilience, most of the proposed definitions included a concept of healthy, adaptive, or integrated positive functioning over the passage of time in the aftermath of adversity. The panelists agreed that resilience is a complex construct and it may be defined differently in the context of individuals, families, organizations, societies, and cultures. With regard to the determinants of resilience, there was a consensus that the empirical study of this construct needs to be approached from a multiple level of analysis perspective that includes genetic, epigenetic, developmental, demographic, cultural, economic, and social variables. The empirical study of determinates of resilience will inform efforts made at fostering resilience, with the recognition that resilience may be enhanced on numerous levels (e.g., individual, family, community, culture). Keywords: Resilience; stress; trauma; post-traumatic stress disorder Responsible Editors: Ananda Amstadter, Virginia Institute for Psychiatric and Behavioral Genetics, VA, USA; Nicole Nugent, Warren Alpert Medical School of Brown University, RI, USA. This paper is part of the Special Issue: Resilience and Trauma . More papers from this issue can be found at http://www.eurojnlofpsychotraumatol.net (Published: 1 October 2014) Citation: European Journal of Psychotraumatology 2014, 5 : 25338 - http://dx.doi.org/10.3402/ejpt.v5.25338

Disaster Resilience Indicators for Benchmarking Baseline Conditions

Abstract: There is considerable federal interest in disaster resilience as a mechanism for mitigating the impacts to local communities, yet the identification of metrics and standards for measuring resilience remain a challenge This paper provides a methodology and a set of indicators for measuring baseline characteristics of communities that foster resilience By establishing baseline conditions, it becomes possible to monitor changes in resilience over time in particular places and to compare one place to another We apply our methodology to counties within the Southeastern United States as a proof of concept The results show that spatial variations in disaster resilience exist and are especially evident in the rural/urban divide, where metropolitan areas have higher levels of resilience than rural counties However, the individual drivers of the disaster resilience (or lack thereof)-social, economic, institutional, infrastructure, and community capacities-vary widely

Community Resilience: Toward an Integrated Approach

Abstract: We explore opportunities for an integrated approach in community resilience to inform new research directions and practice, using the productive common ground between two strands of literature on community resilience, one from social–ecological systems and the other from the psychology of development and mental health. The first strand treats resilience as a systems concept, dealing with adaptive relationships and learning in social–ecological systems across nested levels, with attention to feedbacks, nonlinearity, unpredictability, scale, renewal cycles, drivers, system memory, disturbance events, and windows of opportunity. The second strand emphasizes identifying and developing community strengths, and building resilience through agency and self-organization, with attention to people–place connections, values and beliefs, knowledge and learning, social networks, collaborative governance, economic diversification, infrastructure, leadership, and outlook. An integrative approach seated in the complex ada...