Rocky Mountain Region Disaster Mental Health Conference
February 11-14, 1999
Laramie, Wyoming
CONFERENCE PROCEEDINGS
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.
DAY 1
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.
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References
DISCUSSION AND COMMENTS (If you wish to make comments or enter
a discussion about the above presentation, topic and/or materials, please email:
odoc@mailcity.comYour comments will be posted here and others can respond.):
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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.
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PRESENTER: Suzanna Rose, MA, RN
Research Counsellor
Cognition, Emotion and Trauma Group
Department of Psychology
Royal Holloway
University of London
UK
uhjt001@vms.rhbnc.ac.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).
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REFERENCE INFORMATION
The Cochrane Library - http://www.cochrane.co.uk
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.
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References
DISCUSSION AND COMMENTS (If you wish to make comments or enter
a discussion about the above presentation, topic and/or materials, please email:
odoc@mailcity.comYour comments will be posted here and others can respond.):
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PRESENTER: Renee Garfinkel, Ph.D.
President, Adoption Studies Institute
Editor: "Adoption Quarterly"
Private Clinical Practice
Washington, DC
reneeg@erols.com
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!'"
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DISCUSSION AND COMMENTS (If you wish to make comments or enter
a discussion about the above presentation, topic and/or materials, please email:
odoc@mailcity.comYour comments will be posted here and others can respond.):
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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
debb@doh.state.nm.us
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.
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DISCUSSION AND COMMENTS (If you wish to make comments or enter
a discussion about the above presentation, topic and/or materials, please email:
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