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Rocky Mountain Region Disaster Mental Health Conference

February 11-14, 1999

Laramie, Wyoming


Mental health professionals from many parts of the world as well as 21 states within the US and Washington, D.C. gathered at the University of Wyoming's Extended Studies Building from February 11-14, 1999 for the Rocky Mountain Region Disaster Mental Health Conference. For four days, Educators, Psychologists, Disaster Services Coordinators, Social Workers, Counselors, and researchers presented information, research and networked with each other. What follows below is a day-by-day summary of the Conference Proceedings.


Debriefing/Defusing, Mass Casualty And Airline Disasters

Following a brief welcome by the Dean of the School Of Extended Studies and Associate Vice Provost of the University of Wyoming Dr. Judy Powell and from the Mayor of Laramie, Dave Williams, the conference was opened with brief remarks from George Doherty, the Conference Chair. He cited an article by AJW Taylor, Ph.D. DHC (Reims), Emeritus Professor, School of Psychology, Victoria University, Wellington, New Zealand. Dr. Taylor was originally scheduled to make a presentation at the conference, but was unable to attend. He sent his paper which was included in the packet of materials made available to conference participants. Dr. Taylor's paper "Towards The Classification Of Disasters And Victims" is an important contribution suggesting a schema for the classification of disparate phenomena relating to disasters and victims. This schema came about as a result of the 1979 DC-10 crash on Mt. Erebus in Antarctica. Dr. Taylor had been involved in providing clinical services following this crash and worked closely with those doing recovery efforts and the multi-component team that followed up victim identification in the Auckland Mortuary in New Zealand (Taylor, 1987). Conference participants and presenters were made aware of his paper and they were encouraged to read it while attending the conference. It was suggested to the attendees and presenters that they consider adopting two definitions presented in Dr. Taylor's paper as those for this conference. Dr. Taylor initially define disasters as: "a sudden or great misfortune, an event of ruinous or distressing nature, a calamity; suffering death, injury, ruin, etc., as a result of an event, circumstance, or oppressive or adverse impersonal (or interpersonal) agency". He initially defines a victim as: "a person suffering death, injury, ruin, etc., as a result of an event (or) circumstance". Taylor (1999), however, goes on to make a good case for even more inclusive definitions of disaster and victim. In his paper on classification of disasters and victims, he defines disasters as: "catastrophic events which seriously overtax the resources of individuals, their families, their communities, the organizations in which they work, and sometimes threaten their vital cultural traditions." (Taylor, 1999) Similarly, Dr. Taylor defined victims as: "people whose lives have been affected adversely by their direct or indirect exposure to catastrophe, whether or not they might have contributed to their misfortune." (Taylor, 1999) Using the above definitions, Taylor develops a classification schema which attempts to pull together disparate phenomena related to disasters and research on different kinds of disasters which had been widely scattered both conceptually as well as graphically. His classification schema for disasters and victims provides a useful model for conceptualizing previously unrelated phenomena related to both. Certainly, it deserves attention as a method for integrating disaster studies. ***************************************************************************************************************
DISCUSSION AND COMMENTS (If you wish to make comments or enter a discussion about the above presentation, topic and/or materials, please email:
Your comments will be posted here and others can respond.): **************************************************************************************************************** **************************************************************************************************************** Suzanna Rose, MA,RN opened the conference as the initial presenter. She presented a critical systematic review of the literature in both the US and Europe on Psychological Debriefing and Evidence-based Practice and brief early psychological interventions following trauma. Her presentation was followed by Renee Garfinkel, Ph.D., who spoke about the Poetry of Recovery. Dr. Debra Boehme presented information about the New Mexico Crisis Response Network. Julian Ford, Ph.D. presented a lecture on Acute Psychological Intervention Following Traumatic Stressors: Empirical Findings. He discussed the efficacy of debriefing as the result of attendee evaluations and satisfaction surveys. In an evening presentation, Dr. Gerard Jacobs discussed Mass Casualty and Airline Disasters. His presentation focused on the Aviation Disaster Family Assistance Act of 1996. ******************************************************************************************************************************************************

Psychological Debriefing and Evidence-based Practice

PRESENTER: Suzanna Rose, MA, RN Research Counsellor Cognition, Emotion and Trauma Group Department of Psychology Royal Holloway University of London UK The conference opened with a background and critical systematic review of the literature in both the US and Europe presented by Suzanna Rose. She is a research counselor at the Cognition, Emotion and Trauma Group in the Department of Psychology at Royal Holloway at the University of London. She is also a clinical nurse specialist in psychological trauma at the Posttraumatic Stress Clinic in London's West Middlesex University Hospital. She has worked for the British Red Cross and prior to the 1991 Persian Gulf War, she went to Baghdad and brought out hostages from Iraq. She also counseled relatives of those who died in the Locharbie plane terrorist bombing over Scotland in 1988. The title of Suzanna Rose's presentation was "Psychological Debriefing and Evidence- based Practice". She presented information from a systematic review of the literature on brief early psychological interventions following trauma. Her review found only six randomized controlled trials. None of them included group interventions. Of these six trials, there were only two studies that associated the intervention used with a positive outcome. Two showed no differences on outcome between the intervention and non-intervention groups. Two other studies showed negative outcomes for some of the intervention group. Rose suggested that perhaps the optimism over early psychological interventions, including debriefings, was not warranted. She also suggested there is an urgent need for randomized trials of group debriefing and other early interventions. Her presentation set the tone for the conference and sparked much discussion about the usefulness of debriefing, as well as interest in defining what the term "debriefing" really means. It appears to be used in different contexts in different ways. Both terms "debriefing" and "defusing" perhaps need to be operationally defined when and where used. In establishing the efficacy of these interventions, it is necessary to have definitions, develop a standardized approach using that definition, empirically evaluate the process and outcome and use randomly assigned groups. Such an endeavor is a difficult one to accomplish in most Disaster Mental Health settings. However, it is not impossible. Suzanna Rose has submitted articles on this topic to both "Counselling", British Association of Counseling Journal (in press) and to Traumatology-e (under Review). ***********************************************************************************************************
The Cochrane Library - The Cochrane Library is an electronic publication designed to supply high quality evidence to inform people providing and receiving care, and those responsible for research, teaching, funding and administration at all levels. It is published quarterly on CD-ROM and the Internet, and is distributed on a subscription basis. The Abstracts of Cochrane Reviews are available without charge and can be searched. **********************************************************************************************
References DISCUSSION AND COMMENTS (If you wish to make comments or enter a discussion about the above presentation, topic and/or materials, please email:
Your comments will be posted here and others can respond.): **********************************************************************************************

The Poetry of Recovery

PRESENTER: Renee Garfinkel, Ph.D. President, Adoption Studies Institute Editor: "Adoption Quarterly" Private Clinical Practice Washington, DC The afternoon began with the first of two presentations made by Renee Garfinkel, Ph.D. The title of her first presentation was "The Poetry of Recovery". Renee Garfinkel is a psychologist in private practice in Washington, D.C. She is also a Red Cross volunteer who has provided services on a number of disaster operations. She has volunteered with hundreds of people from many different backgrounds. These have ranged from a retired Army General to a cashier at a grocery store. Many of the disasters she has worked on have been plane crashes. Though she did not volunteer to work the recent Swiss Air plane crash in Nova Scotia, Canada, she did relate an interesting experience related to it. The local Red Cross chapter called her and said that a woman who had been watching TV saw that there was such a large response to aid the survivors and the families of the victims. However, when her parents had died in a private plane crash, no one had responded to her. "What about me?" the woman had said. She had called the Red Cross to express her anger about this. Renee Garfinkel offered the woman and her two children a session which she felt was very helpful. She felt that this woman had displayed the classic symptoms of Post Traumatic Stress. In her presentation, Dr. Garfinkel said that "the mental health part of the disaster is the disaster". She gave an example of what she meant, "If your roof falling in doesn't bother you, then what you've got is a carpentry problem. It's the emotionality of the disaster. 'My life is falling apart!'" ********************************************************************************************** DISCUSSION AND COMMENTS (If you wish to make comments or enter a discussion about the above presentation, topic and/or materials, please email:
Your comments will be posted here and others can respond.): **********************************************************************************************

Bridging The Gap - The Crisis Response Network

PRESENTER: Debra D. Boehme, Ph.D. State Coordinator New Mexico Critical Incident Stress Management Team and New Mexico Crisis Response Network Department of Health Emergency Medical Services Program Santa Fe, NM Dr. Boehme presented information about the New Mexico Crisis Response Network. She had just completed giving a two-day workshop on CISM and the Mitchell Model of debriefing to over 90 emergency managers, police and fire personnel, and mental health professionals over a compressed video system to five sites around the state of Wyoming. Dr. Boehme discussed the fact that the New Mexico Department of Health considers violence to be a major public health problem in New Mexico. This was defined as including homicide, suicide, domestic violence or sexual assault, or resulting from man-made or natural disasters such as vehicle crashes, tornadoes or explosions. Response efforts emphasize a proactive and integrated response in communities, schools, workplaces, etc. She referred to the following response model: "If one considers violence as a disease process, the approach to addressing violence should perhaps resemble a comprehensive epidemiological response to a serious communicable or infectious disease outbreak. Based on the knowledge that people are often more receptive to discuss and take action during, and immediately after, a crisis, various supportive and preventive interventions should be rapidly focused at the individual, family, community and societal levels following significant critical incidents." In her presentation, Dr. Boehme discussed the following Vision Statement of the New Mexico Crisis Response Network: * To ensure that all citizens and communities have access to timely and comprehensive support services in response to violence and other crises. * To coordinate and enhance comprehensive crisis response services at the local level utilizing a case management approach to support/meet the physical, emotional, legal, spiritual and educational needs of victims, their families, caregivers and the broader community. * To develop commitment, leadership and resources within the Department of Health to establish a centralized point of coordination for resource mobilization, training, data collection and advocacy for comprehensive crisis response and violence prevention on a statewide basis. * To assist communities with implementing violence prevention initiatives that work. Dr. Boehme said that the response and prevention model used in New Mexico represents a partnership between response resources at the community level and a central unit with a statewide focus. The model recognizes that there are some communities who have an extensive capacity for response and are able to manage most of their own incidents through school-based programs, victim assistance coordinators, mental health center teams, etc. She pointed out that there are also many local areas who currently lack such capacity and would need support from outside. The New Mexico Crisis Response Network is creating a statewide network of support resources which will be mobilized as needed for response and prevention. Dr. Boehme said that, functionally, the New Mexico Crisis Response Network cooperative system which is under development will include the following components and services: Education/Communications; Notification/Assessment; Centralized Resource Center; Post- event Care of Mobilized Resources; Public Information/Prevention Opportunities; Data Collection; Analysis and Evaluation; and Reassessment. ****************************************************************************************************************


DISCUSSION AND COMMENTS (If you wish to make comments or enter a discussion about the above presentation, topic and/or materials, please email:
Your comments will be posted here and others can respond.): ****************************************************************************************************************