Psychosocial Assistance Without Borders

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We in Greenleaf Integrative Strategies are currently in the process of organizing technical assistance in Mumbai to psychosocial and mental health workers responding to the recent terror attacks. The Government of India’s National Disaster Management Authority has deemed there to be a major shortage in professionally-trained, disaster-prepared practitioners.

Greenleaf's programs include Professional Development and Continuing Education that work best in the late acute or post acute periods of mass disaster. We will play a supportive role to practitioners (therapists, spiritual care providers & health care workers) in order to enhance the sustainability of disaster response.

It is of the utmost importance that practitioners do not prematurely burnout or develop trauma themselves in the process of working in the midst of terrorized people. Supervisors and organizations can learn how to manage practitioners’ stress levels with self-care and other methodologies in order to mitigate vicarious traumatization, secondary traumatic stress and compassion fatigue.

A report released this week by the RAND Corporation, focusing on the rates of PTSD, major depression, and traumatic brain injury in Iraq/Afghanistan war veterans. Researchers also conducted focus groups with military families and spouses about these issues and a model of the economic impact of these conditions.

The authors of the report recommend that effective programs incorporating evidence-based care must be developed to treat veterans experiencing problems such as PTSD and major depression, and suggest that such programs would actually have a negligible or even net positive cost due to their mitigation of the negative economic impact associated with these events.

There is a summary and free download of report results here:
RAND Center for Military Health Policy Research (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: The RAND Corporation.

The Meyer Foundation supports capable, community-based organizations that foster the well-being of all people in the Washington DC region.

According to Meyer Foundation's national survey of nearly 6,000 next generation leaders. a skilled, committed, and diverse pool of next generation leaders would like to be nonprofit executive directors in the future, However, the survey also finds that there are significant barriers: work-life balance, insufficient life-long earning potential, lack of mentorship...

These children serve in a variety of different capacities: as cooks, as quartermasters, as sexual slaves and as combat troops. Their experiences can result in high exposure to profoundly traumatic events, placing them at extreme risk for the development of serious emotional disorders. Psychosocial services targeting former child soldiers are required to help these children transition from their roles as members of armed forces back into a healthy and stable civilian life.

Brief Summary with link to the 100+ page report

Laura Murray and Paul Bolton have worked together to develop a model for how to conduct high-quality research (including a randomized and controlled trial) and service delivery in culturally appropriate ways in low-resource countries. Their approach begins with a relatively quick (three weeks or less) ethnographic and qualitative study to help identify culturally specific definitions of distress and inform the selection of measures and interventions. This article describes this ethnographic phase in detail, and discusses the utility of using it in interventions designed to reduce the impact of disasters.

Here is their article:
Bolton, P., & Tang, A.M. (2004). Using ethnographic methods in the selection of post-disaster mental health interventions. Prehospital and Disaster Medicine, 19(1), 97-101.

One part of being scientific-minded means being skeptical and contrarian. So I am going to challenge resiliency on a website so dedicated to Resiliency.

A subtle premise of many unscientific resiliency workshops and trainings is that “Everyone is Resilient.” This myth finds itself in crisis against the real finding that some damage strikes very deep.

Childhood Trauma, the Neurobiology of Adaptation & Use-dependent Development of the Brain is a field-changing article in which Bruce Perry, et. al. argues that our brains (particularly young brains) cannot always be resilient. Brains can be malleable -- adapting to trauma in ways that only make sense in the context of horror. This malleability can account for the inexplicable and sometimes unsavory behavior of people who have been secretly affected by trauma.

The non-scientist (layperson) will enjoy reading paragraphs #2, #3 and then review the “Key Points” at the end of the article.

Bruce Perry, MD, PhD, the lead author of the Childhood Trauma article referenced earlier, is a child psychiatrist and brain scientist at Baylor College of Medicine. I attended medical school at Baylor, and when Perry taught, his passion for preventing trauma and safeguarding children made a deep impression on us.

While resiliency should be bolstered in all reasonable and rational ways, we must keep another eye towards preventing traumatic stimuli; because bouncing back from every trauma may not be neuro-biologically possible. It is useful to know that traumatic stimuli -- even in the absence of a physical blow or injury -- induce a cascade of neurotoxic insults to brain tissue. Sometimes we can clear the toxin, and sometimes our coping skills are overwhelmed.

Equally important, if we believe that resiliency is possible for everyone, then we secretly judge those who do not demonstrate resiliency as weak or “not trying hard enough.” While resilience is of the utmost importance to pursue, we in the field should never confuse non-recovery from trauma as evidence of failed resilience.

Our duty in trauma work is to temper the discourse of resilience with the reality that some people do not recover. Prevention being the best medicine is why those of us who work in trauma recovery are indebted not only to appropriate law enforcement, but also to the champions of human, civil, and children rights.