1. Community Based Interventions

2. History of Community Based Interventions Purposes New or uncharted territory Mixed findings on effectiveness Emerging Research Policy/Procedures have been developed based on consensus panels

3. Contexts for Intervention Mass Traumas –Post 9-11 (Project Liberty http://www.projectliberty.state.ny.us/) http://www.projectliberty.state.ny.us/ –Post Natural Disaster –Post school shootings

4. Goals of Intervention Focused on the prevention of formal mental disorders –PTSD –Depression –Substance Use –Enhance functioning/coping

5. Challenges Facing Interventions Chaotic, rapidly changing environments Limited Infrastructure Frequently the ‘helpers’ are also affected Variability in training of the ‘helpers’ Mass Scale Those affected are not necessarily interested in treatment

6. Basic Elements of Interventions Provision of basic needs Triage Psychological First Aid Outreach and information dissemination Technical assistance, consultation and training Treatment

7. Goal of Recovery Efforts Recovery efforts foster the survivor’s ability to continue task-oriented activity, regulate emotion, sustain positive self-value, and maintain and enjoy rewarding interpersonal contacts

8. Intervention Phases Little empirical support for interventions offered within the first 14 days Critical incident debriefing –Single session –Two randomized controlled trials have found a greater incidence of negative outcomes for those receiving CISD compared to those who did not

9. Immediate Response Period All responders should focus on basic needs (safety, shelter, food, rest) Empathic contact Traditional treatment is not appropriate at this point

10. Triage Survivors are assessed for those who may need immediate psychiatric assistance –Several Weeks post trauma –Can the survivor continue task oriented activity –How effective are they in these activities –Extent and pervasiveness of extreme emotions –Can emotions be modulated? –Level of isolation, alienation

11. Psychological First Aid These ‘interventions’ focus on meeting basic needs for physical safety, connectedness, security ad survival Survivors can share thoughts, feelings or experiences but this is not ‘required’ Goals include engagement, providing safety, stabilization, gathering information, providing assistance and connecting with social support, providing information and connecting with social services

12. Secondary Psychological Assistance Builds upon psychological first aid Builds upon the goals of psychological first aid by adding problem solving, promoting risk reduction, promoting resilience and recovery Link with collaborative services

13. Conclusions Most individuals exposed to mass trauma don’t need or want formal psychological interventions Existing interventions build upon individual strengths and existing social support More research needed on the efficacy of web based and email based interventions