2. It ain’t over....but we’re moving forward Doug Faust, PhD

3. Dedication To those who stayed Those who joined us in the re-building

4. Planning for a hurricane, new orleans style If you go out of town.... 3 day supplies of medication money clothing

5. There is nothing like a good catastrophe...Somewhere else Late decisions to evacuate Folks used the 3 day model

8. Speculated with those around as to implications

10. Locked out of home communities, schools, jobs

11. Meaningful returns started October 1

13. How’d ya do? We didn’t do so badly

14. 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

15. 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

16. Perceived distance Immediacy Chronicity frequency severity

17. 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

18. Provider Sequence First Responders EMT/Fire/Police Wildlife Services Just about anyone else Disaster & Catastrophe ARC/DRN Order out of chaos Emergency Services Short Term

19. Second Responders

20. 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

21. Second Responders Traditional therapeutic community Primary Community Mental Health Academic Clinics Hospitals Community group/private practices

22. Second Responders Traditional therapeutic community Tertiary care— Role of Emergency rooms Psychiatric Hospitals Unique role of Charity Hospital

23. Impact on the practitioner Primary trauma Serial trauma Secondary/vicarious trauma Compassion fatigue Therapy fatigue burnout

24. Shared TRauma Distressed professional Impaired professional Role of colleague assistance

25. Shared TRauma Has sustained primary trauma Working with concurrently traumatized population

26. Shared Trauma Shock and awe Collateral Traumatization Shared Trauma Serial Traumatization Direct property damage Loss of jobs

27. Practitioner Issues Therapeutic Imperative Disaster centers/shelters Residual Centers Guerilla Therapy Therapy Fatigue/exhaustion Secondary Trauma Compassion Fatigue

28. Best Practices

29. Evidence Based Interventions Eye Movement Desensitization and Reprocessing (EMDR) Cognitive behavioral therapy (CBT) Trauma Focused CBT (TF-CBT)

30. Evidence Based Interventions Cognitive behavioral therapy (CBT) psychoeducation anxiety management exposure techniques cognitive restructuring

31. Evidence Based Interventions Trauma Focused CBT (TF-CBT) cf. deblinger, mannarino, cohen; locally Walker/PFDL Structured intervention Integrates trauma narrative Stepped program

32. Guerilla therapy Anywhere, anytime Flexible delivery

33. Guerilla therapy Little or no training in trauma work Essentially no knowledge of best-practices

34. Guerilla therapy Unrealistic expectations Boundary problems Poor distinction between catastrophe services and second response

35. Guerilla therapy Competition for service dollars Stafford act Competition for jobs

36. Guerilla therapy Alternative therapies How to respond?

37. Alternative Therapies Critical Incident Stress Debriefing (CISD) Thought Field Therapy Meditation Deep Breathing Guided imagery Acupuncturists without borders

38. Four Phases of Community Response to trauma Heroic Phase Honeymoon Phase Disillusionment Phase Recovery and Reconstruction

39. Heroic Phase Communities Pull Together During and immediately following a disaster, individuals and communities often respond supportively, altruistically, and heroically. Disaster response ARC/DRN Shelter support

40. Heroic Phase Disaster response ARC/DRN Shelter support

41. Heroic Phase Unique experiences Therapy community as part of evacuee group Recipients, not just providers, of care Shock and awe/PTSD

42. 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

43. Honeymoon Phase Attention Stays Focused on the Victims Therapist community as “victims” Dissolution of practice community personal losses diaspora lack of disaster training loss of infrastructure

44. Disillusionment Phase Helpers Leave & Residents are Left to Face Reality Longest phase of recovery Immediate response teams leave Assistance and help weakens

45. Disillusionment Phase Losses become a reality Outflow of residents up to 30 months Widespread discouragement

46. Disillusionment Phase Widespread discouragement Scapegoating, resentment, disagreement Unity fades

47. Disillusionment Phase Looking Forward difficulties in recruitment Increased costs of living Chronic problems Medical care Education Utilities

48. 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.

50. Constantly redefined

51. Social and economic activities recover

52. Gradual return to normal routines

53. Completion of reconstruction and recovery efforts

54. Community tries to find a new normal

55. Anniversary events

57. Survey Approx 200 psychologists and 60 social workers Invited by email to participate online survey Approx 25% participation

58. Characteristics of SampleGender 70% were female

59. Characteristics of SampleAge Most were Middle aged

60. Characteristics of SampleMarital Status 61% were married 14% of sample reported a change in marital status since the storm

61. Characteristics of SampleRace 94% of respondents identified themselves as Caucasian

62. Characteristics of SampleProfessional Identification 25% SW; 75% Psychol

63. Characteristics of SampleYears of Professional Experience Almost 50% with > 20 y experience

64. 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

65. Characteristics of SampleEvacuate Prior to storm 28% did not evacuate Prior to Katrina

66. 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

67. Impact of stormResidence 89% reported damage to their homes 44% report persistent damage at 30 months

68. Impact of stormWorkplace 73% reported damage to their offices or workplace 27% report persistent damage at 30 months

69. Hurricane Related Workplace Alternatives Inter/Intra-state commuting; part time practices Borrowed workspaces Internet/Coffee shops Some slept in their offices Academic positions cut

70. Impact of stormIncome 63% reported loss of income due to the storms 26% report that their income is still negatively impacted at 30 months

71. 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

72. Hurricane Related Decisions to Return Employment by one family member School relationships for children Job opportunities – or lack thereof

73. Hurricane Related TraumaDecisions to Return Existing support groups, family, referral base Altruistic intent Increased valuation of professional skills

74. Percentages Involved in Hurricane Related Recovery Activities

75. Percentages Involved in Hurricane Related Recovery Activities

76. Impact of stormMental Health 96% reported acute emotional impact 66% report persistent problems in mental health which they attribute to storms at 30 months

77. 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

78. recommendations Think locally Think cross disciplinary

79. 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.

80. 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

81. 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

82. How could have state or national organizations been more helpful? Waiver of continuing education requirements Where was LPA? Waiver of state organization fees

83. 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?”