One cannot discuss working with populations affected by crisis and trauma without discussing the crisis counselor or social worker as well. An over- looked element of crisis work is the responsibility of the mental health pro- fessional to engage in appropriate self-care. Rachel Kaul’s (this volume) first- person account of her two years of work providing crisis counseling and psychological first aid to victims and first responders after the attack on the Pentagon emphasizes this important feature of effective response to disasters. Inattention to elements of self-care can result in fatigue and in traumatic stress reactions on the part of the crisis clinician that can compromise his or her ability to provide mental health care for others.
CONCLUSION
The attack of September 11, 2001, resulted in huge personal, psychological, and financial traumas. Such community disasters can overload our tradi-
tional coping methods. This is particularly evident among the thousands of citizens who worked in or lived near the World Trade Center or Pentagon prior to September 11. Mental health professionals and emergency respond- ers are always ready and eager to aid persons in crisis. However, prior to September 11, no one had anticipated that the United States would be vic- timized in an assault of the magnitude that occurred; therefore, the health care and mental health organizations were not prepared with an interagency coordinated disaster mental health response. With the increased threat of terrorist activity in the future, in the United States and throughout the world, mental health educators and practitioners must develop the following: train- ing and certification programs for crisis intervenors and trauma specialists; systematic and empirically tested procedures and protocols for crisis re- sponse, crisis intervention, and trauma treatment in the event of a future mass disaster or terrorist attack; and coordinated interagency disaster mental health teams on-call and ready for rapid deployment to community disasters in their respective regions.
Behavioral clinicians, mental health counselors, and social workers are increasingly being expected to respond quickly and efficiently to individuals and groups who are in need of crisis intervention and time-limited, trauma- focused treatment. This overview presented the ACT conceptual model to help communities respond to survivors of disasters and prepare for the fu- ture. Concerns about the growing threat of violence in corporations, manu- facturing facilities, hospitals, and educational institutions are resulting in organizational pressure being placed on practitioners to be skilled in effec- tively assessing risks and unmet needs and providing rapid intervention. Roberts’s (1991, 2000) seven-stage crisis intervention model provides clini- cians with a useful framework to follow. Lerner and Shelton’s (2001) 10-step trauma assessment and intervention model also provides a useful framework to facilitate the recovery of survivors of traumatic events. These conceptual models will assist practitioners in facilitating effective crisis resolution and trauma reduction.
A number of studies and a meta-analysis have demonstrated that certain population groups benefit from crisis intervention programs. Females in the 15–24 and the 55–64 age groups benefited the most from suicide prevention and crisis intervention programs (J. Corcoran & Roberts, 2000). The re- search on the effectiveness of crisis intervention programs with people pre- senting with psychiatric emergencies also shows positive outcomes; however, those clients with preexisting severe personality disorders usually benefited from crisis intervention only when it was augmented with short-term inpa- tient treatment followed by twice-a-week outpatient treatment and medica- tion management (J. Corcoran & Roberts, 2000). The research on the effec- tiveness of crisis intervention after the September 11 terrorist attack has yet to be completed. Therefore, it is recommend that future studies should be strengthened by including standardized crisis assessments at pretest, posttest,
and follow-ups, along with determining preexisting psychiatric conditions. In addition, whenever possible, matched naturally occurring comparison groups or quasi-control groups (no crisis intervention) should be created. Most important, longitudinal follow-up studies, whether through face-to- face or telephone contact, should be administered at uniform periods (e.g., 1 month, 3 months, 6 months, 12 months, 24 months, 36 months, 5 years, and 10 years post–initial crisis intervention). Independent evaluators or re- searchers or university-based researchers should be hired or contracted with by crisis intervention units of local community mental health centers, victim assistance programs, and outpatient hospital clinics.
In the next five to 10 years we will begin to learn the results of longitudi- nal research on the psychological impact of the September 11 terrorist disas- ters on children, adolescents, and adults. Therefore, it is important for dis- aster mental health researchers and criminologists to start planning and implementing studies now. Because of the vulnerability of U.S. citizens to terrorist attacks, federal, state, and local training and educational curricula development activities should be given priority now, so that mental health professionals are better prepared to meet the mental health needs of our citizens in the event of future terrorist disasters.
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