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Learning From The Past and Planning For The Future
MENTAL HEALTH MOMENT February 13, 2004 "If you plan for a year, plant a seed; if you plan for ten years, plant a tree; if you plan for 100 years, educate the people." - Ethiopean Proverb
Short Subjects
LINKS Rocky Mountain Region
Disaster Mental Health Institute
CONFERENCES AND WORKSHOPS:
CRISES IN RURAL AMERICA
Crisis Interventions And
Critical Incident Stress Management:
Current Status and Future Directions
April 21-24, 2004
Casper, Wyoming
Registration: 1-800-442-2963 ext 2212
Society of Australasian
Social Psychologists 33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
27th National AACBT Conference
(Australian Association for
Cognitive and Behavior Therapy)
May 15 - 19, 2004
Location: Perth, Western Australia
AUSTRALIA
Society of Australasian Social Psychologists
33rd Annual Meeting
April 15 - 18, 2004
Location: Auckland, NEW ZEALAND
Contact: SASP@auckland.ac.nz
Deadline for submissions: 1 February 2004WFPHA 10th International Congress on
Public Health: Sustaining Public Health
in a Changing World: Vision to Action
April 19-22, 2004
Location: Brighton, ENGLAND
Contact: Allen K. Jones, PhD
Secretary General World Federation of
Public Health Associations
Email: stacey.succop@apha.orgXIV. IFTA World Family Therapy Congress
March 24 - 27, 2004
Location: Istanbul, TURKEY
14th Biennial Meeting of the Society
for Research in Human Development
(formerly the Southwestern Society for
Research in Human Development -- SWSRHD)
April 1 - 3, 2004
Location: Park City, Utah, USA
7th European Conference on Psychological Assessment
April 1 - 4, 2004
Location: Malaga, SPAIN
Contact: Antonio Godoy
Facultad de Psicologia
Universidad de Malaga
29071 Malaga.( SPAIN)
Tel. (34) 952 13 25 32
Fax (34) 95213 11 00
Email: godoy@uma.esAnnual Conference Society for
Industrial/Organizational Psychology (SIOP)
April 2 - 4, 2004 Location: Chicago, Illinois, USA
Email: lhakel@siop.bgsu.edu
FEMA And Deparment Of Interior Partner To Advance Tribal Communities Use Of Electronic MappingThe Department of Homeland Security's Federal Emergency Management Agency (FEMA) has signed an interagency agreement with the Department of Interior to promote the use of electronic mapping in tribal communities. The mapping, known as GIS, would help tribal governments better protect their communities against all hazards, in part by allowing the inventory of resources and identification of shortfalls in emergency operations planning. For the Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=11074
Disaster Funds Ordered For South Carolina Ice Storm Recovery
The head of the U.S. Department of Homeland Security's Federal Emergency Management Agency (FEMA) designated 17 South Carolina counties eligible for federal disaster funds to help local governments recover from last month's crippling ice storm. Michael D. Brown, Under Secretary of Homeland Security for Emergency Preparedness and Response, said the assistance was authorized under a major disaster declaration issued by President Bush following a review of the agency's analysis of the state's request for federal aid. The declaration covers damage to public property from the storm that occurred over the period of January 26-30. For the Full Story, Go To: http://www.fema.gov/news/newsrelease.fema?id=11159
UN urges unhindered humanitarian access to Haiti's north
The United Nations is calling for a humanitarian corridor to be established in Haiti to allow aid workers access to the country's north, which has been cut off for days because of the violence convulsing the Caribbean nation's cities. For The Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9765&Cr=haiti&Cr1=
Annan urges science for all nations to promote development goals
United Nations Secretary-General Kofi Annan has called for all countries to put greater emphasis on developing their capacities in science and technology, saying that building a reservoir of knowledge in these areas could help the world tackle ills ranging from extreme poverty to illiteracy. For The Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9774&Cr=science&Cr1=
UN agencies to airlift emergency supplies for Sudanese refugees in Chad
The United Nations food relief and refugee agencies are airlifting urgent supplies to eastern Chad to help the tens of thousands of Sudanese refugees who have fled the civil conflict in Darfur. The UN World Food Programme (WFP) plans to send 40 tons of emergency supplies - including high-energy biscuits and logistics equipment - from its depot in Italy to N'Djamena, the Chadian capital. For The Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9761&Cr=chad&Cr1=sudan
Improving lives of elderly with information technology focus of UN event
The goal of enriching the quality of life of today's ageing population through information and communications technology (ICT) would be impossible without meaningful public diplomacy, according to one of the keynote speakers at a meeting held today at United Nations Headquarters in New York. Former United States Congressman Benjamin Gilman told a press briefing that as part of his address, he had encouraged participants to develop a campaign for public diplomacy. In that connection, he recommended that communities form advisory councils, liaise with business and marketing experts, develop good messengers and work with the media. For THe Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9743&Cr=information&Cr1=technology
UNESCO chief condemns yet more murders of journalists
For the fifth time this year the head of the United Nations Educational, Scientific and Cultural Organization (UNESCO) condemned the murder of journalists today as “an intolerable undermining” of one of the pillars of democracy, this time deploring the killings of reporters in the Philippines and Nicaragua. “It is essential that such crimes be punished,” Director-General Koïchiro Matsuura said of the shooting of Ruel Endrinal in Legaspi City in the Philippines on 11 February and Carlos Guadamuz in Managua, Nicaragua, on 10 February. For The Full Story, Go To: http://www.un.org/apps/news/story.asp?NewsID=9758&Cr=UNESCO&Cr1=
EXPERTS: CONSUMERS HAVE MOVED PAST "MAD COW" SCARE
Judging by unchanged sales of fast-food beef, a Penn State meat expert says, American consumers aren't worried about beef safety in the wake of the United States' first known case of BSE. Bill Henning, professor of dairy and animal science, says, "It appears as if consumers realize (that the 'mad cow' case from last year) was an isolated case. It seems most consumers believe that steps taken by the U.S. Department of Agriculture are adequate to give them confidence that beef is safe." However, the USDA's prohibition of "downer" -- lame, weak or disabled -- cows from entering the food chain is having a pronounced effect on dairy and beef farmers and small slaughter plants, Henning notes. Read the full story at http://live.psu.edu/story/5593
UK Study Shows Gulf War Veterans Healthy
Veterans of the 1991 Gulf War--many of whom complain of "Gulf War Syndrome"--are on average as healthy as soldiers who were not sent to the region, Britain said on Wednesday. For THe Article, Go To: http://www.medscape.com/viewarticle/467427?mpid=23960
Physicians Say UK Cannabis Reclassification May Endanger Public Health
Medical groups warned that the British government's decision to downgrade cannabis from a class B to a class C drug could endanger public health. For THe Full Story, Go To: http://www.medscape.com/viewarticle/467405?mpid=23960
UK Establishes Nationwide Chronic Fatigue Syndrome Centers
Twelve new centers devoted to treating and supporting patients with chronic fatigue syndrome (CFS) are due to be established in Britain, the government announced on Tuesday. For The Full Story, Go To: http://www.medscape.com/viewarticle/467359?mpid=23960
PTSD Common in ARDS Survivors
The investigators speculate about the mechanism of trauma and about other medical situations that may lead to posttraumatic stress disorder. For The Full Story, Go To: http://www.medscape.com/viewarticle/467218?mpid=23960
THE MEDICAL MINUTE: PROTECTING OUR MOST PRECIOUS CARGO
This is National Child Passenger Safety Week -- a good time to reduce the chance that your child will be among the 622 children injured or the four children who die on our roadways each day. The latest edition of the Medical Minute, a service of Penn State Milton S. Hershey Medical Center, offers advice on using booster seats and seat belts, and lists resources to turn to for readers with questions about driving children safely at different stages of their development. Read the full story at http://live.psu.edu/story/5554
RURAL TRAUMA
Background And The Problems
Within one year, in the early 1990's, a small rural American town experienced a series of traumatic events. A number of individuals put in much time and effort toward a crisis plan, known as the Trauma Intervention Plan, which ultimately failed. Taplitz-Levy (2002) explored the factors that added to and detracted from the success of the specific school-based collaborative intervention and research project. The attitudes of crisis team members toward the crisis plans, collaborative work, and research were examined using a series of qualitative research methods. Through qualitative analysis of the data, results show that the Trauma Intervention Plan was hindered by poor communication, a lack of trust, and poor historical relationships between the school team and the out of school consultants. Taplitz-Levy's study gives compelling reasons for school personnel and local community mental health staff to develop positive relationships.
In June 1981, south-eastern Kentucky experienced serious and widespread flooding. In May 1984 a storm system brought tornadoes, strong winds, and severe, extensive flooding to this same area. Norris, Phifer & Kaniasty (1994) studied the psychosocial impact of these events. Their study had three features that hold particular promise for increasing what we know about the effects of disaster: (1) the study's prospective and longitudinal design; (2) its consideration of both individual and collective aspects of disaster exposure; and, (3) its focus on older people (age 55 or older). This study addressed the following questions: What impact did these two floods have upon the mental, physical, and social functioning of the rural Appalachian victims? Were these individuals able to take these events "in stride" or did they present a serious challenge to their ability to cope? Did these floods leave a lasting impact upon the mental and physical well-being of these individuals or did they only result in relatively minor and short-lived emotional upset? Were some people more affected than others? Were these communities able to "rally around" their members or were they shattered and split apart?
In September 1991, in the small rural town of Hamlet, NC, the fryer exploded at a chicken processing plant killing 25 employees and injuring many more. This disaster stirred national attention, influenced state law and inspection policies, and profoundly affected the entire community. Derosa (1995) examined the relationship between PTSD and the survivors' subjective experiences of the trauma, their search for meaning and their perceptions of self, of others and of the world around them. They attempted to capture the survivor's experiences of themes such as rage, grief, and a belief in a benevolent world, in conjunction with clinical diagnosis of PTSD (using the SCID interview) in order to assess the buffering or exacerbating influence of the subjective experience. Seventy-eight subjects included plant employees, relatives of employees, rescue personnel, and relatives of fire/rescue personnel. They examined several categories of variables: unresolved trauma themes, 'pre-fire' variables including neuroticism, history of traumatic experiences and previous psychiatric treatment, "peri-traumatic" variables including dissociation, fear of injury and level of exposure to the fire, as well as types of social support, and demographics. The most robust variables contributing to lifetime diagnosis of PTSD after the fire were having lower socio-economic status, being female, feeling little social support, fearing death/injury and dissociating during the fire. The only significant contribution to the model for chronic PTSD was number of unresolved trauma themes. The degree to which the trauma themes remained maladaptive varied by severity of diagnosis. Exploratory cluster analyses of patterns of unresolved themes among survivors and their families suggested that in addition to the number of unresolved themes, the pattern of thematic resolution is associated with diagnosis.
In 1992, El Salvador ended a twelve-year civil war which caused tremendous social upheaval. Approximately 50,000 civilians were killed, 500,000 displaced, and 750,000 to one million left the country (Lundgren, and Lang, 1994). The impact of the violence left many survivors with traumatic emotional problems. Oakes (1998) studied three rural communities in El Salvador. She examined the emotional reactions to war of eighty respondents analyzing the data from the point of view of respondents. Respondents included those who had only indirect war experiences, those who experienced occasional traumatic events during the war, and those who lived in a war zone and had continuous and extreme experiences during the war. Respondents reacted to everyday events, violence, and war with an escalating pattern of emotions. This pattern began with worries often connected to everyday events, then fears often related to violence, and then to emotional states including "nervios" and affliction, and finally to sadness caused by loss. Some physical reactions related specifically to war, such as jumping at noise, while others, such as headaches, were experienced by all, regardless of amount or type of war experience. Past war experiences often affected how respondents reacted emotionally to everyday events in the present, especially when those events were linked to danger or violence. Respondents who had only indirect exposure to war reacted to present and future events only occasionally and mildly through the standpoint of past events in war, while individuals who had prolonged and extreme war experiences reacted to present and future events much more intensely and regularly through the viewpoint of war. In an additional analysis of a small group of respondents who had lived through extreme warfare, Oakes reported that they had few emotional reactions to normal events that they did not relate to war. She suggested that the sum of many people's emotional reactions, therefore, may cause such configurations of people to have reactions to events that are not based on present reality.
Since 1994, lethal violence toward people suspected of witchcraft has escalated in rural communities in South Africa. Hundreds of older people believed to be witches have been burned to death and thousands who have escaped death have taken refuge in government established camps. Hill (2000) examined a group counseling approach that promotes "sustainable reconciliation" with traumatized individuals in communities divided by violence due to witchcraft persecution. Specifically, Hill examined a single case sample of a group counseling session aimed at reconciliation. Fifteen group members included individuals from conflictual parties from geographic areas in South Africa where there are witch burnings. Beyond the 15 group members, 11 other participants rated the group session and its potential for fostering sustainable reconciliation. These 11 individuals were divided into two groups: (a) American student raters (N = 3) and (b) South African observers ( N = 8). This study was constructed as a 10 step process of data gathering and a "constant comparison" (Strauss & Corbin, 1994) of data categorized by all participants. As defined by Glaser and Strauss (1967), the Grounded Theory methodology allowed for an emergence of common themes across raters that could be related to theories for sustainable reconciliation, trauma counseling, group process, and witchcraft persecution. The results of this study suggest that sustainable peace is possible using the "reconciliation group counseling" approach. With these specific types of groups, special consideration must be given to leadership style, building safety, and including the entire community that has been effected by witch persecution. However, according to participants, reconciliation groups will fail if the fundamental reasons for the violence continue to go unattended (e.g., poverty, unemployment). Such fundamental issues perpetuate feelings of fear and hopelessness in community members which fosters an unstable environment. These results suggest that therapists must understand the context of such violence, attend to the trauma symptoms of individuals, and perhaps play a supportive role in the group. The South African observers suggested that successive counseling groups, with public admittance of behavior and retribution for losses would be necessary before sustainable peace could be possible.
The above studies have identified variables, approaches, interventions and make suggestions for a variety of events that produced trauma in rural areas. The following section presents results of studies involving the effects of various trauma-producing events on children, parents and families.
Children, Parents And Families
Youth Violence
Slovak (2000) addressed gaps in the youth violence literature by exploring the types and levels of children's violence exposure in a rural setting. He/she also examined the psychological trauma associated with violence exposure. This study was a secondary data analysis which utilized the rural sample (N = 549) from a larger study. The larger study had conducted a 45 minute questionnaire with students in grades 3 through 8. The questionnaire was designed to tap into children's present and past violence exposure as a victim and witness across the home, school, and neighborhood. This questionnaire also assessed children's trauma symptoms. Slovak found that children in the rural sample were exposed to high amounts of violence as both a victim and witness within and prior to the past year. In general, more boys reported being victims or witnesses to an at least sometimes violent event within the past year compared to girls except for the act of being touched in a private place. In addition more students in the lower grades reported being the victims and witnesses of violent acts compared to students in upper grades. Students reported that home was the place where they were most likely to be victims of violence, with the school being the next most likely place to be victimized at least sometimes. The neighborhood was reported as the least likely place for students to be victims of violence at least sometimes within the past year. Students reported a different trend for witnessing violence. They reported that school was the most likely place to witness violence, with the neighborhood being second. The home was the site reported as the least likely place to witness violence at least sometimes within the past year. Slovak also found that violence exposure variables explained a significant amount of variance in anxiety, anger, dissociation, depression, PTSD and total trauma score above demographic variables. This is consistent with the literature examining the association of trauma and violence exposure. These findings can be utilized to inform policy, practice, and research conducted in rural areas. In addition, the documentation of children's exposure to violence in a rural setting can help banish the stereotype that rural communities are safe havens from violence.
Peltzer (1999) identified exposure to experiences such as violence and the consequences for health in children in a rural South African community. The stratified random sample included 68 (46%) boys and 80 (54%) girls in the age range of 6-16 yrs. Their ethnicity was Northern Sotho. The interviews included the Children's Posttraumatic Stress Disorder Inventory and the Reporting Questionnaire for Children. They grouped experiences into either traumatic or other events. 99 (67%) had directly or vicariously experienced a traumatic event which included witnessing someone killed or seriously injured, serious accident, violent or very unexpected death or suicide of loved one, sexual abuse or rape of relative or friend, violent crime, child abuse, and other life-threatening situations. Scores on the Children's Posttraumatic Stress Disorder Inventory of 17 (8.4%) fulfilled the criterion for posttraumatic stress disorder (PTSD). 71% had more than one score and 53% had more than four scores on the Reporting Questionnaire for Children. Posttraumatic stress symptoms were significantly related to age and experiences such as those mentioned above.
Gun Violence
Slovak & Singer (2001) compared rural youth (Grades 3-8) exposed to gun violence and rural youth not exposed to gun violence on a number of variables: anger, anxiety, dissociation, depression, posttraumatic stress, total trauma, violent behavior, parental monitoring, and levels of violence in the home, school, and community. One-fourth (25%) of the 549 Ss reported having been exposed to gun violence at least once. Youth exposed to gun violence reported significantly more anger, dissociation, posttraumatic stress, and total trauma. In addition, youth exposed to the violence of guns reported significantly higher levels of violent behaviors and exposure to violence in other settings and also reported lower levels of parental monitoring. This study contributes to the growing body of literature addressing the stereotype that rural communities are not immune to the violence of firearms. This stereotype can act as a barrier to mental health practice, research, and policy issues in rural communities.
Slovak (2002) investigated the relationship between access to firearms and parental monitoring on rural youths' exposure to gun violence and examined the effect of gun violence exposure on the mental health of these youths. She administered a survey to 162 students (mean age 14.3 yrs) who participated in a student assistance program that provided in-school support groups for students in grades 6 through 12. Her results show that a substantial number of students were exposed to gun violence and exposure was significantly related to firearm access and parental monitoring. Furthermore, gun violence exposure was significantly associated with trauma among the youths. Implications for mental health workers include advising high-risk clients and their families on gun removal and safe storage practices.
Abuse
While recent research has focused on the impact of abuse and other interpersonal traumas in childhood, little attention has been given to the experiences of children who have been removed from their homes. In addition to trauma, these children are likely to have had a number of experiences that may impact their current functioning. Brady & Caraway (2002) provide descriptive information pertaining to the unique characteristics of children in residential treatment centers, and examines preliminary factors believed to be associated with current functioning. Participants included 41 children, aged 7-12 yrs old, recruited from two treatment centers in the rural Midwest. Children were administered the Trauma Symptom Checklist for Children and participated in a brief interview. Each child's primary caregiver at the facility completed the Child Behavior Checklist. Results of the descriptive analyses painted a picture of chaotic childhood marked by significant stress and trauma. Gender, child's satisfaction with current discharge plan, and multiple traumatic experiences were found to be associated with variations in symptomatology. Brady & Caraway's findings may assist service providers and caregivers in understanding the unique experiences of this population.
Miller & Veltkamp (1988) provide a clinical perspective on the accounts of sexual abuse of children allegedly occurring in a small, rural community. Variables that are related to the degree of psychological trauma experienced by the child include types of sexual abuse (such as incest), age of the child, duration of sexual abuse, degree of coercion or aggression and threat, the adult (known or unknown), the degree of activity, and the adult/parent response. Miller & Veltkamp addresse 8 characteristics of the family constellation in abusing families, the multigenerational pattern, specific behavioral indicators of sexual abuse and stages of experiencing sexual abuse and emotional trauma in children, treatment of the sexually abused child and abusive family, and guidelines from the American Academy of Child Psychiatry (1986) for use by clinicians and legal experts in evaluating sexual abuse.
Partner Violence
Partner violence is a serious mental and physical health concern leading to debilitating physical injury in women. Significant psychological sequelae are associated with battering. However, only recent investigations have begun to delineate the different types of psychological distress. The diagnosis of Posttraumatic Stress Disorder (PTSD) has been useful in characterizing the symptoms associated with victims of severe trauma. The DSM-IV criteria for PTSD include re-experiencing trauma, avoidance responses, and heightened arousal. Given the characteristics shared between battered women and other victims of violent crime, Presty (1996) predicted that battered women develop primary features of PTSD. The second hypothesis was that other women would meet DSM-IV criteria for Acute Stress Disorder (ASD). She also performed exploratory analyses to examine relationships between the frequency and severity of abuse and diagnostic categories. The results confirmed the two hypotheses. First, 65.6% of the sample was PTSD-positive, with 5% meeting criteria for ASD. Other anxiety disorders accounted for 13.1%. The prevalence rate of Major Depressive Disorder (MDD) was 70.5%. The comorbidity of depression with PTSD was 84.6%. Physical abuse significantly predicted PTSD development, explaining 11.4% of the total variance. Verbal abuse significantly predicted MDD. Dissociation was predicted by both verbal and physical abuse. Exploratory cluster analysis revealed three typologies of battered women. Cluster 1 reflected young, poorly educated women, who experienced the greatest physical and sexual abuse. They had the highest levels of PTSD, moderate depression, and the poorest level of functioning. Cluster 2 women were the oldest, had the most children, and had the longest relationship duration. They experienced more verbal than physical abuse, and had the highest degree of depression, with modest PTSD severity. Cluster 3 reflected the youngest, most educated group, with the least number of children, and shortest relationship duration.
Murder/Suicide
Following a murder/suicide at the Red Lion Junior High School in Red Lion, Pennsylvania, (the second critical incident in two years for this school district), a crisis response team provided critical incident stress management (CISM) services, response coordination and ongoing support to the students, teachers, parents and community of this small town (Seebold, 2003). Their response team was a diverse blend of professionals from the school district, Pennsylvania State Education Association, school psychologists, and the local employee assistance program (EAP). Within eight days, the school population had moved beyond a horrifying critical incident to begin the process of recovery. This suggests that CISM teams can facilitate recovery following such incidents.
Vicarious Trauma
Connery (2003) examined acute symptoms and functional impairment related to September 11 terrorist attacks among rural community outpatients with severe mental illness. Connery conducted a retrospective chart review for 133 community patients with severe mental illness for the time interval between September 11 and December 31, 2001. This chart review revealed that patients with severe mental illness, even if they are located far from the primary site, can experience vicarious trauma reactions in association with terrorist events. This is consistent with the results of a national study of immediate stress reactions to September 11 among the general population. In summary, this retrospective chart review showed that 18 of a sample of 133 patients with severe mental illness receiving assertive community treatment experienced significant acute stress reactions to the threats of terrorism during the 3 months following September 11, 2001.
Cultural Considerations
Grief Reactions
Fabrega & Nutini (1994) examined the psychological and behavioral concomitants of grief among parents in rural Mexico who experienced sudden and unexpected death of infants and young children. Particular focus was given to the local concept of malevolent witchcraft as an explanation for the deaths. Data on 47 cases of witchcraft-explained deaths were collected as part of a longitudinal study in the early 1960s. Parents constructed a social and psychological picture of the death of their infants that had naturalistic elements (i.e., parental culpability, how the death occurred) that were given a supernatural interpretation. The tragedy was socially shared, and commonality was forged in the ordeal of coping with the trauma. A case illustration was included to illustrate the contrast between social and psychological constructions of reality. The use of symbols to construct meaningful accounts of tragedies and to regulate and restore social relations was described.
Benswanger, Baider & Cornely (1980) present a profile of seven families from rural communities in Pennsylvania Appalachia, each of whom had experienced the death or grave illness of an infant. Geographic, cultural, psychological, and demographic factors were examined to evaluate in its entire context the impact of infant death/illness in this area. Benswanger, Baider & Cornely suggested that such an ecological outlook will allow research to develop effective interventions that will decrease the rural incidence and trauma of infant death.
Dislocation
Mandic & Mihaljevic (1993) reported results of a three month group and individual study with 593 displaced persons of different sexes, ages, marital status, and education. Ss were observed for 12 wks from the moment when they had to leave their homes in the rural parts of East Croatia, their arrival to Osijek and accommodation in social centers. Having been forced to leave their homes and villages, it was an extremely stressful event exceeding the usual life experience and resulting in psychosocial, physiologic, and psychobehavioral disorders. Only 6.5% of men and 2.4% of women behaved rationally. Psychosocial disorders occurring immediately after leaving their homes were ranked as follows: fear (24.7%), anger and fury (23%), distrust (16.1%), anxiety (12.9%), and despair (7.5%) in men, and fear (34.2%), anxiety (14.8%), panic (15.9%), despair (14.8%), distrust (9%) and fury (8.8%) in women. Concern about the future, own life, parents, property and siblings occurred more often among women. After a 22-wk treatment period, 30% of men and 40% of women reported disorders which were grouped as insomnia, loss of appetite, functional disturbances, increased irritability and depressive mood.
Civil Rights
Rogers (1994) examined the oral narratives of five African-American women and men who were active in the civil rights movement in the deep south in the 1960s. At various times in their five years with the movement in New Orleans and rural Louisiana and Mississippi, these individuals experienced terrorism and violence from segregationist Whites. Some suffered from battle fatigue due to continual exposures to danger and loss. Mid-life interviews with seven former members of New Orleans' chapter of the pacifist, interracial Congress of Racial Equality (CORE) and two of their lawyers--known collectively in New Orleans as the CORE family--illustrate the incorporation of collective and individual trauma into mature personal narratives. Rogers argues that activists have developed two narrative forms to encapsulate their complex experiences within the civil rights movement--trauma narratives and narratives of redemption. She further argues that mid-life narratives indicate that activists have used these episodes of trauma and redemption to frame and contextualize their life trajectories as consistent with their youthful politics.
It is important to include individual and community level interventions as well as collaborations with relief agencies in addressing crises in culturally different rural environments. Mental health responders are encouraged to broaden their skil;ls to include training in disaster, critical incident and crisis interventions as global awareness of the need for such responses increases.
Responses
Smith, Thompson & Shields (1997) evaluated the effectiveness of a rural emergency medical and trauma services project in increasing the knowledge and confidence of emergency personnel (pre-hospital and hospital) in assessment and management of acutely ill and injured children. Providers from an intervention county who were compared with control providers demonstrated a significantly greater increase in test scores that measured knowledge of pediatric emergencies. Intervention field and hospital personnel also demonstrated significantly greater improvement. Intervention county providers had a significantly greater decrease in anxiety when confronting a scenario of a child with respiratory arrest. They also had a greater increase in confidence about management of the pediatric airway and a greater increase in the adequacy of their pediatric training. Smith, Thompson & Shields concluded that this project offers a model that can be replicated in other rural areas.
Teletherapy/Telemedicine
Patients injured in rural areas die at roughly twice the rate of those patients with similar injuries in urban areas (2). A multitude of explanations have been suggested for higher mortality rates from trauma in the rural areas of the United States. Since rural emergency room (ER) staff see far fewer traumas than ER staff at large metropolitan trauma centers, their lack of exposure to this low-volume problem certainly contributes to the problem. To address discrepancies in trauma education and the delivery of care in rural regions. Ricci, Caputo & Amour (2003) report on a telemedicine system that was utilized to provide rapid consultation from surgeons at the level 1 trauma center and to provide enhanced educational opportunities for rural ambulance emergency first responders. Forty-one "tele-trauma consults" were performed over the first 30 months of the project, all for major, multi-system trauma. Though many clinical recommendations were made, the system was judged to be life saving in three instances, and both rural and trauma center providers felt the system enhanced clinical care. Early results of a telemedicine system provide encouragement as a means to address discrepancies in the outcomes after major trauma in rural areas, although more work needs to be completed and evaluated.
Although access to health care for rural patients remains a critical challenge, teletherapy may represent a viable means for the delivery of therapeutic services to them. Teletherapy represents an effective and efficient means for providing rehabilitation services for patients in rural communities, and for facilitating mentoring relationships between seasoned professionals and trainees located in rural areas.
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REFERENCES Benswanger, Ellen G.; Baider, Lea; Cornely, Paul J. (Spr 1980). Infant death in rural community: Implications for research and intervention. Journal of Rural Community Psychology, Vol 1(1), pp. 25-46.
Brady, Kristine Lynn & Caraway, S. Jean (Nov 2002). Home away from home: Factors associated with current functioning in children living in a residential treatment setting. Child Abuse & Neglect, Vol 26(11), pp. 1149-1163.
Connery, Hilary Smith (Jan-Feb 2003). Acute symptoms and functional impairment related to September 11 terrorist attacks among rural community outpatients with severe mental illness. Harvard Review of Psychiatry, Vol 11(1), pp. 37-42.
Derosa, Ruth Reed (Dec 1995). Post-traumatic stress disorder and the subjective experience of disaster: The Hamlet fire. Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 56(6-B), pp. 3441.
Dudley-Grant, G. Rita; Mendez, Gloria I. & Zinn, Juliana (Aug 2000). Strategies for anticipating and preventing psychological trauma of hurricanes through community education. Professional Psychology: Research & Practice, Vol 31(4), pp. 387-392.
Fabrega, Horacio & Nutini, Hugo (Dec 1994). Tlaxcalan constructions of acute grief. Culture, Medicine & Psychiatry, Vol 18(4), pp. 405-431.
Falicki, Zdzislaw; Borowski, Tadeusz; Kalinowski, Antoni (1972). The opinions of rural population on psychic diseases. Polish Medical Journal, Vol. 11(1), pp. 213-219.
Fiasche, Angel (1967). Investigation of a chain of suicides in a rural community. Psychotherapy & Psychosomatics, 15(1), pp. 20.
Forducey, Pamela G.; Ruwe, William D.; Dawson, Stephen J. (2003). Using telerehabilitation to promote TBI recovery and transfer of knowledge. NeuroRehabilitation, Vol 18(2), pp. 103-111.
Hill, Michele B. (2000). Building sustainable reconciliation in South African communities experiencing witch burnings. Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 60(12-B), pp. 6018.
Lombas, Tiffany Marie (Jun 2002). A naturalistic exploration of stress and coping among rural law enforcement officers: Implications for the counseling profession. Dissertation Abstracts International Section A: Humanities & Social Sciences, Vol 62(11-A), pp. 3701.
Mandic, Nikola & Mihaljevic, Zeljka Vuksic (Dec 1993). Psychologic state of displaced persons from East Slavonia. Socijalna Psihijatrija, Vol 21(3-4), pp. 121-135.
Miller, Thomas W. & Veltkamp, Lane J. (1988). Child sexual abuse: The abusing family in rural America. International Journal of Family Psychiatry, Vol 9(3), pp. 259-275.
Norris, Fran H.; Phifer, James F. & Kaniasty, Krzysztof (1994). Individual and community reactions to the Kentucky floods: Findings from a longitudinal study of older adults. In: Ursano, Robert J. (Ed) & McCaughey, Brian G. (Ed); Individual and community responses to trauma and disaster: The structure of human chaos. New York, NY, US: Cambridge University Press. pp. 378-400.
Oakes, Margaret Grace (Dec 1998). Emotional reactions to the trauma of war: A field study of rural El Salvador. Dissertation Abstracts International Section A: Humanities & Social Sciences, Vol 59(6-A), pp. 2188.
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To search for books on disasters and disaster mental
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RECOMMENDED READING
Emergency Procedures for Schools: A Disaster Planning Guide for Small School Districts and Rural Aschools
by Ralph W. Ritchie
From Book News, Inc.
From the Publisher
Terrorism: Each of the books in The Emergency Procedures Series has had a Chapter on Terrorism since the World Trade Center Disaster in 2001. Most of the material in these books is applicable to this new kind of disaster, especiaslly personal preparation. Additional material from experts has been provided to enhance the author's experience.
From the Author
The book has been updated to include shootings, bombings, and terrorist's attacks.
Book Description
Disasters are with us, whether we plan for them or not. Frankly, I would rather not be one of those handed a blanket by rescue forces, when or if they arrive. You can get mighty cold and hungry waiting for help. In the case of a school, the problem multiplies by the number of children entrusted to your care. Let's have a quiz. That's something we know lots about: 1. What if 911 doesn't answer? 2. What about emergencies where evacuation is the wrong thing to do? 3. What if you must care for the children in your charge 24 hours or longer, or even for three hours longer. 4. What happens when the parents can't come for their kids and a neighbor does? 5. What if the rest of the community arrives at your doorstep needing help? 6. What if you are the rescue center until FEMA and all the others arrive? 7. Does your personal liability insurance cover negligence? (That's what they call it if you don't have an operational disaster plan.) 8. You sit there, wondering, after a major disaster: lights and electricity are out, no water, no telephone, sewer destroyed, no heat, kids start yelling "I'm hungry!",and a hundred people are pounding on your door yelling HELP. Okay, do something, but what? This book is a head start. It is designed to give you the elements of a plan and a framework on which to hang your answers.
Okay, tax paying citizens and/or parents, the schools are your biggest community investment as well as the place your kids spend about a third of the day. Isn't it time to be sure that your investment in schools is protected, as well as your kids? This book is a good check list to see if they've covered all the bases. It will also give you a background for helping where they need help, and they do need help! You Need This Book!
Additional Readings at:
Also try looking here for September 11, 2001: A Simple Account for Children.
Videos on Terrorism
Other videos about terrorism
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Contact your local Mental Health Center or
check the yellow pages for counselors, psychologists,
therapists, and other Mental health Professionals in
your area for further information.
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George W. Doherty
Rocky Mountain Region
Disaster Mental Health Institute
Box 786
Laramie, WY 82073-0786
MENTAL HEALTH MOMENT Online: https://www.angelfire.com/biz3/news
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