Academic journal article Health and Social Work

Tailoring Disaster Mental Health Services to Diverse Needs: An Analysis of 36 Crisis Counseling Projects

Academic journal article Health and Social Work

Tailoring Disaster Mental Health Services to Diverse Needs: An Analysis of 36 Crisis Counseling Projects

Article excerpt

The federal Crisis Counseling Program (CCP) funds states' delivery of mental health services to communities affected by disasters. The CCP is based on a social work and public health outreach model that stresses proactively bringing services to people wherever they are in the community. Guidance from the CCP to state grantees (U.S. Department of Health and Human Services [HHS], 2003) has long stressed several principles that are related to cultural competence. These include valuing cultural differences, recruiting disaster workers from all segments of the affected community (Cohen, 1984), involving community leaders as advisers and cultural brokers (Gould, 1988; Hernandez, Nesman, Mowery, Acevedo-Polakovich, & Callejas, 2009), encouraging clients to access culturally appropriate sources of support (Ida, 2007), and adapting services to fit the needs of different cultural and linguistic segments of the population (Hernandez, Nesman, Isaacs, Callejas, & Mowery, 2006; Sue, 2006). However, there has previously been little formal evaluation of the extent to which crisis counseling projects embrace these principles and no test of whether projects that strive for cultural competence are in fact more successful in serving the entire affected community.

CCP

Crisis counseling has become an integral component of federal assistance to communities recovering from disasters and other mass casualty events. In 1974, the Disaster Relief Act (P.L. 93-288) established the Federal Crisis Counseling Assistance and Training Program (that is, the CCP) to provide supplemental funding for crisis mental health services to U.S. states and territories affected by federally declared disasters. Administration of such grants is overseen by the Emergency Mental Health and Traumatic Stress Services Branch of the Center for Mental Health Services, within the Substance Abuse and Mental Health Services Administration (SAMHSA). Through this program, U.S. states or territories request federal funding for mental health assistance for an average of 10 to 12 disaster events annually (Norris et al., 2005).

The CCP supports a mix of psychoeducation and brief (typically one- to three-session) counseling services. These activities are intended to accelerate survivors' return to predisaster levels of functioning by educating them about common emotional reactions after disasters; normalizing and destigmatizing their emotional reactions; promoting self-care and positive coping; encouraging use of social supports; facilitating referrals for instrumental assistance for food, housing, medical, and financial needs; and, when needed, offering referral to mental health treatment (HHS, 2000).

The CCP has a strong outreach orientation and aims to bring services to people who might not otherwise seek out mental health assistance. Some outreach principles of the CCP model are providing services in community settings rather than in formal treatment settings, using nonstigmatizing language that does not connote "disorder" or "treatment," recruiting and training indigenous staff drawn from the local community, and hiring a mix of mental health professionals (often social workers) and paraprofessionals who have experience working with local community groups (HHS, 2000).

CULTURE AND RECOVERY AFTER DISASTER

Ethnicity and culture play key roles in how people recover after disasters (HHS, 2003). Although disasters can, and do, affect everyone, disadvantaged racial and ethnic communities are often more severely affected and have more difficulty recovering (Fothergill, Maestas, & Darlington, 1999).

One factor affecting people's ability to recover is economic. Members of economically or socially marginalized groups may have greater unmet needs after disasters (International Federation of Red Cross and Red Crescent Societies, 2007). They are more likely to live in vulnerable areas that may be hardest hit when disasters occur, and they are less able to absorb disaster-related economic losses. …

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