Moving Forward — The Continental Divide Disaster Behavioral Health Conference
October 1, 2007
Introduction: One of the authors of this article, Charles Benight, PhD, will participate in a panel presentation, "Development of an Online Program for Acute Trauma Recovery" at the ISTSS Annual Meeting, November 15-17 in Baltimore.
Disasters ignite a passion to help. The mental health and behavioral health communities are not immune to this response. Following major tragedies, helping professionals sanctioned by federal response teams or by state and or local agencies, as well as independent professionals, respond with intensity and the desire to help.
In the 1980s, models for disaster care were developed and embraced throughout the world. The new millennium brought new models (Psychological First Aid) to replace the controversial “old” models (e.g., Critical Incident Stress Debriefing). What has been missing from our efforts to provide psychosocial care following disasters is high-quality clinical research. In the absence of high quality research, clinicians are left to make decisions without the benefit of empirical evidence.
The breadth and complexity of questions related to disaster response that need answers are daunting. For example:
- How effective is Psychological First Aid (PFA) at alleviating immediate traumatic stress?
- Does PFA impact functioning in a positive way?
- Does early intervention in general decrease the likelihood or the severity of PTSD, Major Depression or a host of Anxiety Disorders that tend to negatively impact the lives of a subset of survivors?
- Is PFA better then Critical Incident Stress Management?
- Is there a difference between early Cognitive Behavioral Treatement (CBT) intervention that is a primary intervention at two-to-three weeks following a trauma and an immediate intervention in the hours after an event?
- Are there ways to directly support and positively impact the individual’s and the community’s resilience after an event in order to decrease long-term negative consequences?
- Do different traumatic events require different interventions or supports from the response community?
- Are there different individual versus community interventions that we should develop?
- Should early interventionists be more concerned with the functioning of the individual or of the community?
- Can we define when PFA (circumstance, timing, participants) should be used as compared to the concepts of Individual Crisis Intervention, Disaster Behavioral Health Triage, and Critical Incident Stress Debriefing?
- Should we provide tangible resources and keep our psychosocial interventions at home until a later date?
It was these types of questions that Dr. Charles “Chip” Benight (University of Colorado – Colorado Springs’ Trauma Health and Hazards Center) and Dr. Curt Drennen (Colorado Department of Human Services Behavioral Health Services) were asking when they decided to undertake a new partnership. In August 2007 their teams successfully launched the first Continental Divide Disaster Behavioral Health Conference: Science to Practice, Practice to Science. One hundred twenty individuals from across the country gathered in Colorado Springs for two days of networking and conversation to look at ways to increase partnerships between scientists in the fields of trauma and disaster with practitioners who provide the services following community tragedy.
The Vision of the CO-Divide conference is the cultivation of partnerships and networks that will lend themselves to effective disaster behavioral health research and practice innovation. We believe that it is not only desirable, it is critical to develop a system that has the research infrastructure in place with working collaborations between disaster mental health scientists and clinical providers to truly begin answering some of these big questions.
We need partnerships from both sides of the research-practitioner “divide” working toward answering these questions. We envision this partnership as a true “two-way street”, where practitioners inform scientists of needs, provide anecdotal evidence, case studies, experimental ideas and direct experience; and scientists provide methods for assessing critical questions, provide statistical analysis, and offer guidance on necessary next steps to the practitioners. The “divide” is wide with ethical barriers which must be carefully managed (e.g., informed consent procedures, confidentiality) increasing the difficulty of moving forward. However, this year’s conference helped to bring the vision into a hopeful view.
The conference had many successes. Josef Ruzek from the National Center for PTSD spoke on Psychological First Aid and issues of follow-up care. April Naturale who directed Project Liberty after 9/11 spoke on the challenges of community-based care following major disasters. Steve Crimando, previous director of New Jersey Emergency Management during 9/11, discussed critical issues related to preparing for pandemic flu. Gayle Cullinan, staff counselor for UNICEF, discussed intervention strategies when dealing with catastrophic disasters in combination with war. Interspersed throughout the plenary talks were breakout sessions that covered a variety of different issues, like school violence, infectious illnesses, resilience building and population triage, to name a few. Finally, the conference closed with a panel discussion of continuing the collaboration development.
The success of this conference could be captured in one word: relationship. Many of the critical questions facing our field were asked, analyzed and discussed. We developed a list of people wanting to actively work on bridging this divide and building a system that can begin answering the questions.
ISTSS will offer a one-day mini-conference on June 16, 2008, at the Royal College of Physicians in central London, U.K. The seminar, open to all ISTSS members and others working in this field, will provide an expert update on current treatments for PTSD. More information about the seminar will be available soon on the ISTSS Web site, in future issues of StressPoints and at the ISTSS annual conference in Baltimore.
If you are interested in being part of moving the disaster mental health field forward, we invite you to consider attending the next Continental Divide Disaster Behavioral Health Conference to be held in Colorado in the first couple of weeks in June 2008 (final date to be announced). We believe the network and partnerships that come from the CO-Divide vision will have a positive impact on not only the survivor, but the rescuer, and the community that surrounds them.