"It Ain't Over... But We're Moving Forward" by Douglass Faust

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"It Ain't Over... But We're Moving Forward" by Douglass Faust

  1. 1.
  2. 2. It ain’t over....but we’re moving forward<br />Doug Faust, PhD<br />
  3. 3. Dedication<br />To those who stayed<br />Those who joined us in the re-building<br />
  4. 4. Planning for a hurricane, new orleans style<br />If you go out of town....<br />3 day supplies of <br /> medication<br /> money<br /> clothing<br />
  5. 5. There is nothing like a good catastrophe...Somewhere else<br />Late decisions to evacuate<br />Folks used the 3 day model<br />
  6. 6.
  7. 7. There is nothing like a good catastrophe...Somewhere else<br />For those who got out<br /><ul><li>Watched progressive destruction on tv/Internet
  8. 8. Speculated with those around as to implications
  9. 9. Tried to get more news</li></li></ul><li>There is nothing like a good catastrophe...Somewhere else<br />For those who got out<br /><ul><li>Evacuees became diaspora
  10. 10. Locked out of home communities, schools, jobs
  11. 11. Meaningful returns started October 1
  12. 12. Consider your losses</li></li></ul><li>How’d ya do?<br />We lost everything<br />
  13. 13. How’d ya do?<br />We didn’t do so badly<br />
  14. 14. How’d ya do?<br />It didn’t Bother us very much<br />Disruptions of everyday life<br />Disruptions of jobs & school<br />Chronic unremitting exposure to damage caused by the storm<br />
  15. 15. The impact of Katrina<br />Forgive my navel-gazing, but I honestly cannot think of a single aspect of my life -- as a writer, a father, a husband, a son, a person -- that is not different from the way it was before. <br /> Chris Rose, Times-Picayune, 3/29/06<br />
  16. 16. Perceived distance <br />Immediacy<br />Chronicity<br />frequency<br />severity<br />
  17. 17. Role of the therapist <br />Typically, One or more degrees of separation from the event<br />In a catastrophe, the therapist may have no degrees of separation from the event<br />
  18. 18. Provider Sequence<br />First Responders<br />EMT/Fire/Police<br />Wildlife Services<br />Just about anyone else<br />Disaster & Catastrophe<br />ARC/DRN<br />Order out of chaos<br />Emergency Services<br />Short Term<br />
  19. 19. Second Responders<br />
  20. 20. Second Responders<br />Evacuate with population<br />Not disaster /catastrophe trained<br />Return to standard practice locations<br />But so many didn’t in the first 30 months<br />90% psychiatry<br />40% psychology/social work/counselor<br />
  21. 21. Second Responders<br />Traditional therapeutic community<br />Primary<br />Community Mental Health<br />Academic Clinics<br />Hospitals<br />Community group/private practices<br />
  22. 22. Second Responders<br />Traditional therapeutic community<br />Tertiary care—<br />Role of Emergency rooms<br />Psychiatric Hospitals<br />Unique role of Charity Hospital<br />
  23. 23. Impact on the practitioner <br />Primary trauma<br />Serial trauma<br />Secondary/vicarious trauma<br />Compassion fatigue<br />Therapy fatigue<br />burnout<br />
  24. 24. Shared TRauma <br />Distressed professional<br />Impaired professional<br />Role of colleague assistance<br />
  25. 25. Shared TRauma <br />Has sustained primary trauma<br />Working with concurrently traumatized population<br />
  26. 26. Shared Trauma <br />Shock and awe<br />Collateral Traumatization<br />Shared Trauma<br />Serial Traumatization<br />Direct property damage<br />Loss of jobs<br />
  27. 27. Practitioner Issues<br />Therapeutic Imperative<br />Disaster centers/shelters<br />Residual Centers<br />Guerilla Therapy<br />Therapy Fatigue/exhaustion<br />Secondary Trauma<br />Compassion Fatigue<br />
  28. 28. Best Practices<br />
  29. 29. Evidence Based Interventions<br />Eye Movement Desensitization and Reprocessing (EMDR)<br /> Cognitive behavioral therapy (CBT)<br /> Trauma Focused CBT (TF-CBT)<br />
  30. 30. Evidence Based Interventions<br /> Cognitive behavioral therapy (CBT)<br /> psychoeducation<br /> anxiety management<br /> exposure techniques<br /> cognitive restructuring <br />
  31. 31. Evidence Based Interventions<br />Trauma Focused CBT (TF-CBT)<br /> cf. deblinger, mannarino, cohen; locally Walker/PFDL<br />Structured intervention<br />Integrates trauma narrative<br />Stepped program<br />
  32. 32. Guerilla therapy<br />Anywhere, anytime<br />Flexible delivery<br />
  33. 33. Guerilla therapy<br />Little or no training in trauma work<br />Essentially no knowledge of best-practices<br />
  34. 34. Guerilla therapy<br />Unrealistic expectations<br />Boundary problems<br />Poor distinction between catastrophe services and second response<br />
  35. 35. Guerilla therapy<br />Competition for service dollars<br />Stafford act<br />Competition for jobs<br />
  36. 36. Guerilla therapy<br />Alternative therapies<br />How to respond?<br />
  37. 37. Alternative Therapies<br />Critical Incident Stress Debriefing (CISD)<br />Thought Field Therapy<br />Meditation<br />Deep Breathing<br />Guided imagery<br />Acupuncturists without borders<br />
  38. 38. Four Phases of Community Response to trauma<br />Heroic Phase<br />Honeymoon Phase<br />Disillusionment Phase<br />Recovery and Reconstruction<br />
  39. 39. Heroic Phase<br />Communities Pull Together<br />During and immediately following a disaster, individuals and communities often respond supportively, altruistically, and heroically.<br />Disaster response<br />ARC/DRN<br />Shelter support<br />
  40. 40. Heroic Phase<br />Disaster response<br />ARC/DRN<br />Shelter support<br />
  41. 41. Heroic Phase<br />Unique experiences<br />Therapy community as part of evacuee group<br />Recipients, not just providers, of care<br />Shock and awe/PTSD<br />
  42. 42. Honeymoon Phase<br />Attention Stays Focused on the Victims<br />Four common patterns of community response:<br />Intense community mobilization<br />Increased community consensus<br />People from outside the community come to help<br />Organizations adapt to help the community<br />
  43. 43. Honeymoon Phase<br />Attention Stays Focused on the Victims<br />Therapist community as “victims”<br />Dissolution of practice community<br /> personal losses<br /> diaspora<br /> lack of disaster training<br /> loss of infrastructure<br />
  44. 44. Disillusionment Phase<br />Helpers Leave & Residents are Left to Face Reality<br />Longest phase of recovery<br />Immediate response teams leave<br />Assistance and help weakens<br />
  45. 45. Disillusionment Phase<br />Losses become a reality <br />Outflow of residents up to 30 months<br />Widespread discouragement<br />
  46. 46. Disillusionment Phase<br />Widespread discouragement<br />Scapegoating, resentment, disagreement<br />Unity fades<br />
  47. 47. Disillusionment Phase<br />Looking Forward<br />difficulties in recruitment<br /> Increased costs of living<br /> Chronic problems<br /> Medical care<br /> Education<br /> Utilities<br />
  48. 48. New Orleans threatened by &apos;brain drain&apos; By MICHAEL KUNZELMAN, <br />It wasn&apos;t the flooding that drove Dr. David Jones out of New Orleans for good. His house in the Lakeview neighborhood stayed dry. Instead, it was the way Hurricane Katrina eroded the orthopedic surgeon&apos;s practice.<br />
  49. 49. Recovery and Reconstruction<br />Finding a New Normal<br /><ul><li>May not occur for a year or more post-disaster
  50. 50. Constantly redefined
  51. 51. Social and economic activities recover
  52. 52. Gradual return to normal routines
  53. 53. Completion of reconstruction and recovery efforts
  54. 54. Community tries to find a new normal
  55. 55. Anniversary events
  56. 56. Difficulty in recovery decisions is compounded by poor planning and preparedness</li></li></ul><li>The Impact of Hurricanes Katrina and Rita on the practice of Psychology in Southern Louisiana: Results of a survey<br />
  57. 57. Survey<br />Approx 200 psychologists and 60 social workers<br />Invited by email to participate online survey<br />Approx 25% participation<br />
  58. 58. Characteristics of SampleGender<br />70% were female<br />
  59. 59. Characteristics of SampleAge<br />Most were <br />Middle aged<br />
  60. 60. Characteristics of SampleMarital Status<br />61% were married<br />14% of sample reported a change in marital status since the storm<br />
  61. 61. Characteristics of SampleRace<br />94% of respondents<br /> identified themselves<br />as Caucasian<br />
  62. 62. Characteristics of SampleProfessional Identification<br />25% SW; <br />75% Psychol<br />
  63. 63. Characteristics of SampleYears of Professional Experience<br />Almost 50% with<br />&gt; 20 y experience<br />
  64. 64. Characteristics of SamplePrimary Practice Setting Prior<br />Of those responding,<br />Majority involved in <br />Private practice<br />Numbers of individuals reporting 50% time or more in each setting<br />
  65. 65. Characteristics of SampleEvacuate Prior to storm<br />28% did not evacuate<br />Prior to Katrina<br />
  66. 66. Hurricane Related Characteristics of the sample<br />15% of sample reported partnership changes<br />Time away from home averaged 9-10 weeks<br />Time away from primary workplace varied markedly<br />
  67. 67. Impact of stormResidence<br />89% reported damage to their homes<br />44% report persistent damage at 30 months<br />
  68. 68. Impact of stormWorkplace<br />73% reported damage to their offices or workplace<br />27% report persistent damage at 30 months<br />
  69. 69. Hurricane Related Workplace Alternatives<br />Inter/Intra-state commuting; part time practices<br />Borrowed workspaces<br />Internet/Coffee shops<br />Some slept in their offices<br />Academic positions cut<br />
  70. 70. Impact of stormIncome<br />63% reported loss of income due to the storms<br />26% report that their income is still negatively impacted at 30 months<br />
  71. 71. Hurricane Related Impact on Income<br />2005 income down 30-50%<br />2006 income down 45%<br />2007 income improving, working harder, lower collection rate<br />A very few salaried individuals had stable income<br />Loss of clients/referrals<br />Loss of jobs, contracts<br />
  72. 72. Hurricane Related Decisions to Return<br />Employment by one family member<br />School relationships for children<br />Job opportunities – or lack thereof<br />
  73. 73. Hurricane Related TraumaDecisions to Return<br />Existing support groups, family, referral base<br />Altruistic intent<br />Increased valuation of professional skills<br />
  74. 74. Percentages Involved in Hurricane Related Recovery Activities<br />
  75. 75. Percentages Involved in Hurricane Related Recovery Activities<br />
  76. 76. Impact of stormMental Health<br />96% reported acute emotional impact<br />66% report persistent problems in mental health which they attribute to storms at 30 months<br />
  77. 77. Impact of stormHelped or supported by profession<br />69% reported that they did not feel supported after the storm<br />82% report persistent feelings that they are not being supported at 30 months<br />
  78. 78. recommendations<br />Think locally<br />Think cross disciplinary<br />
  79. 79. Recommendationstake care of yourself<br />‘In the event of a sudden loss of cabinpressure, masks will descend from the ceiling. Stop screaming, grab the mask, and pull it over your face. If you have a small child traveling with you, secure your mask before assisting with theirs. If you are traveling with more than one small child, pick your favorite.<br />
  80. 80. How could have state or national organizations been more helpful?<br />Increase visibility of Mental Health Community<br />Embracement of social work/counselor models by state <br />Negotiate with state/federal emergency management for reimbursement to local practitioners, rather than johnny-come-lately’s<br />Facilitate grant applications<br />
  81. 81. How could have state or national organizations been more helpful?<br />DRN and Disaster psychology are short term, needs of the practice community are long lasting<br />Who takes care of the second responders<br />Support groups for professionals<br />Emphasis on distress rather than impairment<br />Information clearinghouse<br />Use of state and national databases to facilitate organization of local professionals and support groups<br />Support groups for professionals, CE on disaster recovery<br />
  82. 82. How could have state or national organizations been more helpful?<br />Waiver of continuing education requirements<br />Where was LPA?<br />Waiver of state organization fees<br />
  83. 83. How could have state or national organizations been more helpful?<br />There was a perception that bringing APA to NOLA was a good show of support, but...<br />No local coordination of activities<br />No notification to psychologists about specialized activities intended to be supportive<br />“what have you done for me lately?”<br />

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