Disaster Mental Health
Counseling: Beyond PFA
Jane Webber, Ph.D. & J. Barry Mascari, Ed.D.
Kean University
•
With the increase in disasters, mass violence, and
shootings, providing effective DMH interventions is critical
for counselors. However, there is scant research on what
works, especially for different cultures and communities.
This session, based on the presenters’ book
Disaster
Mental Health Counseling
, will address current issues of
PFA assessment, stabilization, and long-term needs.
Individual and community-based counseling approaches
What we plan to do today
•
To understand lessons learned from research, expert
panels, and literature on effective disaster mental health
interventions
•
To compare psychological first aid to family crisis
counseling and other disaster counseling approaches.
•
To identify best practices for disaster mental health
counseling in different cultures and communities
•
To find out what concerns you have moving forward, as
counseling has been “late to the dance,” with slow
What the book does: Moving beyond PFA
• Trauma is mentioned and infused in many chapters
• Compassion fatigue takes center stage with self-care
• Retrospectives on Katrina, Virginia Tech, refugees, and international deployments are addressed
• The unique needs of veterans moves beyond the PFA window to a continuum from pre-deployment to post-deployment and the family
• School shootings address the needs beyond initial response, to community healing and a perspective
•
PFA was a response to what
not to do in the
U.S.
•
As theories change with evidence, disaster
response is evolving especially in the era of
mass violence and the proliferation of school
shootings
Evidence Aid Initiative 2013
Top 30 Priorities in Disaster Research
•
Experts rated evidence on the effects of mental health and
psychosocial support interventions in top 30
•
‘However, without a reliable evidence base of
well-performed studies all guidelines will be
expert rather than
evidence-based
.”
•
Limitation: “The lack of evidence for PFA interventions
Belgian Red Cross Flanders Review
•
“However, on the field trauma focused interventions
provided to be ineffective and even harmful” (Dieltjens et
al., 2014).
•
Safe to address needs; thus
psycho-social support
•
Manuals: “
the best available objective evidence is integrated
5 meta-analyses of PTSD Factors
•
“In people affected by a disaster or trauma do certain
PFA interventions promote safety, connectedness,
self and collective efficacy, calm and hope?”
•
No study examined effects of psychosocial measures
to support disaster victims.
•
“Complete lack of high quality experimental ad
•
“Consequently research is needed to
determine the most effective, efficient, and
acceptance interventions before
evidence-based PFA guidelines on how to train
Reasons for Lack of Research Evaluating
Non-Therapeutic PFA Interventions
1. Evidence in prehospital care “scarce in general”; flawed studies
2. Difficult to perform in aftermath, ethical issues, unpredictability of time and context
3. Multifactorial intervention based on Hobfoll’s 5 principles: different forms, contexts and cultures need to be evaluated separately
4. Resistance to evidence based practice, lack of uniform definitions and terminology leading to “several definitions, frameworks, and interventions”
5 Key Principles
(Hobfoll et al., 2007
)
1. Safety
2. Connectedness
3. Self and collective efficacy 4. Calm
5. Hope
• Indirect evidence from related fields, not collected by a systematic
search.
Criteria
1. population-disaster or traumatic event victims; health professional did not diagnose or refer
2. Intervention: community-based interventions; by laypeople, first responders, health care professionals, the victim him/herself, first hours/days, single interventions, “feasible by lay people”
3. Measure mental health parameters (resilience, efficacy,
empowerment, stress, coping, functioning, engagement, etc.) or Physiological parameters (blood pressure or heart rate).
EUROPEAN REVIEWS
• “The absence of quantitative data containing evidence to support PFA makes it impossible to determine whether it is effective or not following traumatic events.”
• “The option of doing nothing, however, risks promoting a sense of lack of social support in those affected which has been associated with the development of PTSD following traumatic events. Many guidelines caution against doing nothing shortly after traumatic
Increase in Secondary Traumatic Stress
•
Greater awareness of STS in responders and the public
•
Lack of knowledge, research base, and assessment tools
•
Impact of social media, TV, and the press moves trauma
experience into the living room
1. Resources emphasize survivor resilience, emotion
regulation and ”bodyfulness” to reduce reflexive
reactivity
2. Interventions in the intermediate and long term
recovery in addition to PFA; Family Crisis Counseling
Model, Outreach
3. Trauma-informed counseling to avoid
re-traumatization
4. PsySTART- Universal Assessment/Triage
5. Common Terminology
6. CACREP Standards
7. Response to Mass Violence - Mass Shootings; neighbor helping
neighbor (nationwide disaster response crisis counselor credentialing & training)
8. Global Climate Changes –Wildfires, floods, radical storms
9. Take concepts/self care out of the treatment and disaster response rooms to share with the general public (brain owner’s manual)
10. Peaceful Skills
11. Integration of brain based techniques as we know more
