"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






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

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