Search

The severe consequences of Hurricane Katrina on mental health have sparked tremendous interest in improving the quality of mental health care for disaster victims. In this special issue, we seek to illustrate the breadth of work emerging in this area. The five empirical examples each reflect innovation, either in the nature of the services being provided or in the evaluation approach. Most importantly, they portray the variability of post-Katrina mental health programs, which ranged from national to state to local in scope and from educational to clinical in intensity. As a set, these papers address the fundamental question of whether it is useful and feasible to provide different intensities of mental health care to different populations according to presumed need. The issue concludes with recommendations for future disaster mental health service delivery and evaluation. [ABSTRACT FROM AUTHOR]

Many disaster survivors suffer from postdisaster distress regardless of whether or not they meet criteria for specific psychiatric diagnoses. Cognitive Behavior Therapy for Postdisaster Distress (CBT-PD), a ten-session manualized intervention, was developed to address a range of cognitive, emotional, and behavioral reactions to disaster. Trained community-based therapists provided CBT-PD to adult survivors of Hurricane Katrina as part of InCourage, a program sponsored by the Baton Rouge Area Foundation. Participants ( n = 88) who were assessed at referral, pretreatment, intermediate treatment, and posttreatment showed significant and large improvements. The overall pre-post effect size was 1.4 in intention-to-treat analyses. Improvements were comparable for persons with more severe distress and persons with moderate distress at referral. Benefits were maintained at follow-up for the 66 adults who have been assessed. [ABSTRACT FROM AUTHOR]

Hurricane Katrina created the largest population of internally displaced persons in the history of the United States. Exceptions to Federal Emergency Management Agency’s (FEMA’s) usual eligibility requirements allowed states from across the nation to apply for Crisis Counseling Assistance and Training Program (CCP) grants to provide services to evacuees. Over a 16-month period, crisis counselors documented 1.2 million individual and group encounters across 19 CCPs. Most encounters (936,000, 80%) occurred in Presidential disaster-declared areas of Louisiana, Mississippi, and Alabama, but many (237,000, 20%) occurred in 16 smaller “undeclared” programs across the country. Programs showed excellent reach relative to external benchmarks provided by FEMA registrations for individual assistance and population characteristics. Programs varied widely in service mix and intensity. The declared programs reached more people, but the undeclared programs provided more intensive services to fewer people with higher needs. [ABSTRACT FROM AUTHOR]

The 2005 hurricane season was the worst on record, resulting in disaster declarations and the implementation of federally-funded crisis counseling programs in five states. As part of a larger cross-site evaluation of these programs, data from 2,850 participant surveys, 805 provider surveys, and 132,733 encounter logs (submitted from 3 weeks before to 3 weeks after the participant surveys) were aggregated to the county level ( N = 50) and used to test hypotheses regarding factors that influence program performance. County-level outcomes (aggregate ratings of participants’ perceived benefits) improved as service intensity, service intimacy, and frequency of psychological referrals increased and as provider job stress decreased. The percent of providers with advanced degrees was indirectly related to participants’ perceived benefits by increasing service intensity and referral frequency. The results yielded recommendations for achieving excellence in disaster mental health programs. [ABSTRACT FROM AUTHOR]

During January–April 2007, Project Recovery, a federally funded crisis counseling program implemented by Mississippi’s Department of Mental Health, piloted a new model of Specialized Crisis Counseling Services (SCCS) on the Mississippi Gulf Coast. In this team-based approach, a masters-level counselor trained in a variety of intervention techniques and a resource coordinator worked together with persons whose needs were relatively intense. Compared to regular program (RCCS) participants over the same interval ( n = 29,522), SCCS participants ( n = 281) were more likely to be female, middle-aged, and at greater risk for severe distress. In a participant survey conducted in both programs over the same week, SCCS participants reported significantly greater benefit than did RCCS participants. A subset of 129 SCCS participants provided pre- and post-participation assessments and showed large improvements in disaster-related distress. [ABSTRACT FROM AUTHOR]

An important aspect of crisis counseling is linking survivors with services for their unmet needs. We examined determinants of referrals for disaster relief, additional crisis counseling, and psychological services in 703,000 crisis counseling encounters 3–18 months after Hurricane Katrina. Referrals for disaster relief were predicted by clients’ losses, age (adults rather than children), and urbanicity. Referrals for additional counseling and psychological services were predicted by urbanicity, losses and trauma exposure, prior trauma, and preexisting mental health problems. Counseling and psychological referrals declined over time despite continuing mental health needs. Results confirm large urban–rural disparities in access to services. [ABSTRACT FROM AUTHOR]

Objective: We examined the lifetime prevalence of violence in Mexico and how different characteristics of the violent event effect the probability of meeting criteria for lifetime post-traumatic stress disorder (PTSD).Method: We interviewed a probability sample of 2,509 adults from 4 cities in Mexico (Oaxaca, Guadalajara, Hermosillo, Mérida) using the Composite International Diagnostic Interview (CIDI).Results: Lifetime prevalence of violence was 34%. Men reported more single-experience, recurrent, physical, adolescent, adulthood, and stranger violence; women more sexual, childhood, family, and intimate partner violence. Prevalence was generally higher in Guadalajara, though the impact was greater in Oaxaca compared to other cities. Of those exposed, 11.5% met DSM-IV criteria for PTSD. Probabilities were highest after sexual and intimate partner violence, higher for women than men, and higher in Oaxaca than other cities.Conclusions: It is important to consider the characteristics and the context of violence in order to develop effective prevention and intervention programs to reduce the exposure to and impact of violence. [ABSTRACT FROM AUTHOR]

This article provides a brief overview of the field of disaster research, summarizing what is known at present about the prevalence of disasters, the range of stressors and outcomes experienced, and sample-, event-, and individual-level risk factors for poor health and mental health outcomes. Prior research does not suggest that an urban context either enhances or reduces risk for individual survivors. It is argued, however, that the influence of extraindividual exposure, ethnic diversity, and support deterioration may be especially salient for understanding urban disasters. Investigators of urban disasters are especially well situated to expand knowledge of ecological and collective aspects of disaster response and recovery. [ABSTRACT FROM AUTHOR]