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Mental/Behavioral Health (non-responders)
Topic Collection
November 11, 2024

Topic Collection: Mental/Behavioral Health (non-responders)

Disasters can have tremendous mental and behavioral health consequences that will directly impact healthcare systems in the short and long term. The resources below can help healthcare systems enhance their ability to prepare for and respond effectively to the mental and behavioral health complications that may arise during an emergency. This Topic Collection addresses the impact of post-disaster mental and behavioral health-related challenges on the healthcare system, and includes tools and information providers may use to support the needs of their patients. For additional information regarding disaster mental and behavioral health as it relates to the general public please access ASPR's Disaster Behavioral Health or the Substance Abuse and Mental Health Services Administration's Disaster Technical Assistance Center. ASPR TRACIE’s Select Disaster Behavioral Health Resource Page and Responder Safety and Health Topic Collection also include helpful, related information.

Though this topic collection includes information about diagnoses and interventions that planners should be aware of, it is not designed to be a comprehensive resource for treatment information for conditions such as Post-Traumatic Stress Disorder. Mental health professionals should refer to other sources or contact the agencies noted above for specific questions.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads

Acosta, J., Faherty, L., Landis, R., et al. (2023). Monitoring and Surveillance of Behavioral Health in the Context of Public Health Emergencies: A Toolkit for Public Health Officials. RAND Corporation.

This interactive toolkit can help state, territorial, local, and tribal public health use existing data sources (e.g., unemployment insurance claims, hotline calls, calls to Poison Control Centers, 9-8-8 calls, and use of emergency medical services) during public health emergencies while the development of longer-term data collection efforts are in process.

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American Academy of Child & Adolescent Psychiatry. (2018). Disaster Resource Center.

This webpage provides links to: fact sheets for families written by child/ adolescent psychiatrists; frequently asked questions about a variety of topics; and links to resources for healthcare professionals. Resources include PowerPoint presentations, news and research articles, video clips, and book summaries.

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ASPR TRACIE. (2024). Disaster Behavioral Health: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response.

When disasters strike, the ripple effects can be significant. Incorporating disaster behavioral health (DBH) into all phases of emergency management can ensure resident and responder preparedness, an effective, compassionate response effort, and a more resilient community moving forward. This document provides information on and links to select DBH programs and resources that can be of immediate use to emergency health care providers, emergency management stakeholders, and other professionals and survivors affected by naturally occurring or human-caused incidents.

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Berkowitz, S., Bryant, R., Brymer, M., et al. (2010). Skills for Psychological Recovery: Field Operations Guide. National Center for PTSD and National Child Traumatic Stress Network.

This manual can help disaster behavioral health responders learn about how to help survivors cope with stress and other negative effects after a disaster. This intervention is designed to follow Psychological First Aid support and provides skill-based interventions to the affected individual; links to related resources are provided.

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Center for the Study of Traumatic Stress. (2020). COVID-19 Pandemic Response Resources.

This webpage includes links to various fact sheets on identifying and managing effect of coronavirus and mental health.

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Centers for Disease Control and Prevention. (2018). Coping With a Disaster or Traumatic Event.

This webpage contains links to resources focused on disaster behavioral health. There are resources geared towards individuals, responders, health professionals, and other community members, and some are categorized by hazard. The “Responders: Tips for Taking Care of Yourself” page includes discussion on burnout and self-care techniques.

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Centers for Disease Control and Prevention, Center for Preparedness and Response. (2017). Mental Health Aspects of an Emergency Response.

This hour-long webinar, cosponsored with National Voluntary Organizations Active in Disaster (NVOAD), discusses mental health and spiritual care in emergencies. Speakers discuss stress, stigma, isolation, populations more likely to be adversely affected by specific emergencies, and effective communication to address mental health concerns, including in faith-based settings.

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City of New York, Department of Health and Mental Hygiene. (2018). Providing Psychological First Aid (PFA).

This fact sheet summarizes how psychological first aid (PFA) should be applied during and in the immediate aftermath of disasters to promote safety, calm, connectedness, hope, and self-efficacy. It describes what PFA is and is not, and who should get PFA training.

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Hodge, J.G., Rutkow, L., and Corcoran, A.J. (2010). Mental and Behavioral Health Legal Preparedness in Major Emergencies. Public Health Reports. 125(5): 759-762.

The authors discuss the importance of preparing to address mental and behavioral health problems in affected populations and emergency responders following a major disaster, both programmatically and legally.

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Meredith, L., Eisenman, D., Tanielian, T., et al. (2010). Prioritizing "Psychological" Consequences for Disaster Preparedness and Response: A Framework for Addressing the Emotional, Behavioral, and Cognitive Effects of Patient Surge in Large-Scale Disasters. (Free registration required.) Disaster Medicine and Public Health Preparedness. 4(E1-E8).

The authors share guidance for healthcare facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties.

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Missouri Department of Mental Health. (2013). The Behavioral Health Emergency Plan Template for Health Care Organizations.

This template was developed to assist hospitals and health care providers in integrating behavioral/mental health functions into their emergency plans. This document can serve as a template/checklist.

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National Association of State Mental Health Program Directors and National Technical Assistance Center for State Mental Health Planning. (2003). Mental Health All-Hazards Disaster Planning Guidance. Substance Abuse and Mental Health Services Administration.

This is an instructional guide and template for state disaster mental health planners.

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National Child Traumatic Stress Network. (2009). Psychological First Aid Online.

This online course can help disaster responders learn about psychological first aid and includes mentor tips, activities, and video demonstrations. Links to related resources and a Learning Community are included.

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National Child Traumatic Stress Network. (2013). PFA Mobile™.

This mobile app can help responders who provide Psychological First Aid (PFA). It features a review of the core functions of PFA, helps users match interventions to survivors' reactions, provides mentoring tips, helps users assess their readiness to conduct PFA, and helps track survivors' needs.

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Substance Abuse and Mental Health Services Administration. (2013). Disaster Planning Handbook for Behavioral Health Treatment Programs: Technical Assistance Publication (TAP) Series 34. U.S. Department of Health and Human Services.

The information in this handbook can help behavioral health treatment program staff plan (or enhance existing plans) for all types of disasters. The guide includes informative chapters and templates that can be customized or used as is by program staff.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (2014). SAMHSA Behavioral Health Disaster Response Mobile App.

This app provides first responders access to field resources for aiding disaster survivors, and the ability to search for and map behavioral health service providers in the impacted area, review emergency preparedness materials, and share resources.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2024). Disaster Distress Helpline.

The Disaster Distress Helpline is a free, confidential 24/7 hotline service that provides support for disaster survivors, responders, or anyone experiencing the stress of an event. Users can call or text 1-800-985-5990 and connect with trained and caring professionals from a network of crisis centers across the country. Helpline staff provide supportive counseling, including information on common stress reactions and healthy coping, as well as referrals to local disaster-related resources for follow-up care and support.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Mobile App: PTSD (Post-Traumatic Stress Disorder) Coach.

The PTSD (Post-Traumatic Stress Disorder) Coach app can help users learn about and manage symptoms that often occur after trauma. Features include reliable information on PTSD and treatments that work; tools for screening and tracking symptoms; convenient, easy-to-use tools to help handle stress symptoms; and direct links to support and help.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Reactions Following Disaster and Mass Violence.

This resource discusses how the impact of disaster and mass violence is often widespread, with many people who directly experience the event and many more who witness or are indirectly affected by it. It details responses and interventions for the post-event period, which can be divided into four phases: impact, immediate, intermediate, and long-term.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Working with Trauma Survivors: What Workers Need to Know.

This website provides information on the importance of learning about traumatic stress and how approaching survivors with genuine respect, concern, and knowledge about their process can help move them towards recovery.

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Education and Training

* Berkowitz, S., Bryant, R., Brymer, M., et al. (2010). Skills for Psychological Recovery: Field Operations Guide. National Center for PTSD and National Child Traumatic Stress Network.

This manual can help disaster behavioral health responders learn about how to help survivors cope with stress and other negative effects after a disaster. This intervention is designed to follow Psychological First Aid support and provides skill-based interventions to the affected individual; links to related resources are provided.

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Centers for Disease Control and Prevention, Center for Preparedness and Response. (2017). Mental Health Aspects of an Emergency Response.

This hour-long webinar, cosponsored with National Voluntary Organizations Active in Disaster (NVOAD), discusses mental health and spiritual care in emergencies. Speakers discuss stress, stigma, isolation, populations more likely to be adversely affected by specific emergencies, and effective communication to address mental health concerns, including in faith-based settings.

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Chandra, A. and Acosta, J. (2013). Building Resilient Communities: An Online Training. RAND Corporation.

This course is geared towards community organizations (including healthcare agencies) and can help them understand and strengthen resilience. Materials include checklists, action lists, transcripts, and other support files. The two basic modules take about an hour each to complete.

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DisasterReady.org. (2018). Soft Skills in Crisis Management for Responders.

The goal of this 3-hour course is to equip participants with the skill set to provide effective emotional support to a person affected by a crisis. Though created for United Nations staff, it may be a valuable resource for other mental/behavioral health responders. It consists of six lessons: Principles of Effective Crisis Response; Assessment of Crisis Level; Crisis Reactions; Crisis Response Strategies and Techniques; Self Care for Crisis Responders; and Psychological First Aid.

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* National Association of County and City Health Officials. (2016). Behavioral Health Videos.

This resource provides a series of seven behavioral health videos, available in English, Spanish, and American Sign Language. Video 2 is focused on stress management tips for first responders.

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* National Child Traumatic Stress Network. (2009). Psychological First Aid Online.

This online course can help disaster responders learn about psychological first aid and includes mentor tips, activities, and video demonstrations. Links to related resources and a Learning Community are included.

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National Health Care for the Homeless Council. (2018). Aftermath of Disaster: Addressing Trauma with Mental Health First Aid.

This webinar discusses how providers can utilize mental health first aid to help those traumatized by a disaster find resiliency and the ability to start rebuilding their lives. It discusses what makes disaster trauma unique from other traumatic experiences, and how disaster trauma impacts those who already struggle with homelessness, poverty, and other social or medical issues.

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Natural Hazards Center. (2019). CONVERGE Training Modules. (Free registration required.)

The Natural Hazards Center is developing these modules "to advance social science and interdisciplinary extreme events research efforts through identifying, mapping, and training a diverse group of researchers." Two modules are currently available: Social Vulnerability and Disasters and Disaster Mental Health.

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Office of the Assistant Secretary for Preparedness and Response. (2021). A Guide to Compassionate and Empathic Dialogue - Presentation. U.S. Department of Health and Human Services.

This presentation describes the guide ASPR and the Americares Foundation, Puerto Rico Region developed to help emergency response and recovery personnel engage effectively and empathically with their stakeholders in a multi-hazard environment. It includes an overview of the emotional phases of a disaster, the essential steps of offering compassionate and empathic communication, and supportive evidence-based information and resources. Available in Spanish: https://files.asprtracie.hhs.gov/documents/guia-para-un-dialogo-compasivo-y-empatico-presentaci-n.pdf

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Prepare Iowa. (2013). Effect of Disasters on Mental Health: Awareness Level.

This course is designed for those who come into contact with disaster survivors, including first responders and healthcare providers. It is designed to help these professionals learn more about the effects of disaster-related trauma, and includes practice exercises and review questions.

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Prepare Iowa. (2013). Effect of Disasters on Mental Health: Technical Level. (Prerequisite: Effect of Disasters on Mental Health: Awareness Level.)

This course is designed for those who come into contact with disaster survivors, including first responders and healthcare providers. Participants will learn more about assessment and intervention both right after a disaster and in the weeks and months afterwards. A module on cultural awareness is also provided.

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Schonfeld, D.J. (2011). Supporting Children's Mental Health Needs in the Aftermath of A Disaster: Pediatric Pearls. (Requires Real Player or Windows Media Player.) Alabama Department of Public Health.

This 90-minute video includes information on how healthcare providers can help children cope with stress in the wake of a disaster. The target audience includes clinical staff (e.g., pediatricians and family physicians), and mental health professionals and social workers who work with children and their families. A link to the slides and reading list are also available.

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Stoddard, Jr., F., Pandya, A., and Katz, C. (2011). Disaster Psychiatry: Readiness, Evaluation, and Treatment. (Book available for purchase.)

The authors discuss readiness, response, and intervention, and provide an overview of the evidence base for psychiatric evaluation for disaster survivors.

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The National Child Traumatic Stress Network. (2020). Skills for Psychological Recovery (SPR) Online*.

Skills for Psychological Recovery (SPR) is a 5-hour interactive course designed for providers to help survivors gain skills to manage distress and cope with post-disaster stress and adversity. This course is for individuals who want to learn about using SPR, learning the goals and rationale of each core skill, delivering SPR, and supporting survivors in the aftermath of a disaster or traumatic event (https://learn.nctsn.org/enrol/index.php?id=535 *).

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Tulane University School of Public Health and Tropical Medicine. (2023). Evidence-Based Approaches for Post-Disaster Mental Health Disorders.

This course discusses common post-disaster mental health problems such as acute stress disorder and post-traumatic stress disorder (PTSD), as well as approaches for dealing with those problems. It reviews data on post-traumatic syndromes, data on immediate response strategies for prevention, current rationale for a screen and track response strategy, and the social psychology of non-clinical post-disaster responses.

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University at Albany Center for Public Health Preparedness, State University of New York. (2015). CDR HEPC (Capital District Regional Health Emergency Preparedness Coalition) Pediatric Disaster Mental Health.

This training provides a broad overview of potential mental health care needs for the pediatric patient involved in an emergency/disaster situation. It is part of a full-day training sponsored by the Capital District Regional Health Emergency Preparedness Coalition. Topics covered include typical emotional and behavioral responses of children to highly stressful events by developmental age; psychological first aid, including information-gathering techniques; assessments of survivors' immediate needs; and implementation of supportive activities.

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University of Minnesota, School of Public Health. (2017). Psychological First Aid: A Minnesota Community Supported Model. (Free registration required) U-SEEE Preparedness and Emergency Response Learning Center (U-SEEE PERL).

This course provides an overview of the concepts and applications of Psychological First Aid and is intended for Medical Reserve Corps volunteers, hospital personnel, disaster responders, and first-responders.

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Ursano, R., Fullerton, C., Weisath, L., et al. (2011). Textbook of Disaster Psychiatry. (Book available for purchase.)

This book can help disaster responders learn more about disaster psychiatry and includes chapters on the neurobiology of disaster exposure, socio-cultural issues, workplace policies, and implications for public health planning at the level of the individual and the community.

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Guidance

American Academy of Child & Adolescent Psychiatry. (2018). Disaster Resource Center.

This webpage provides links to: fact sheets for families written by child/ adolescent psychiatrists; frequently asked questions about a variety of topics; and links to resources for healthcare professionals. Resources include PowerPoint presentations, news and research articles, video clips, and book summaries.

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American Psychiatric Association. (2018). How Climate-Related Natural Disasters Affect Mental Health.

This web page discusses how climate change poses a threat to public health, including mental health. Lists of links to other resources are provided.

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Bulling, D., Zagurski, R., and Hoffman, S. (2007). Behavioral Health Guidelines for Medical Isolation. University of Nebraska Public Policy Center and University of Nebraska Medical Center.

This document is geared towards healthcare providers working with patients in isolation. The authors provide information related to stress and anxiety and how to help patients cope with these feelings. Tips for working with families, staff, and the community (when appropriate) are also included.

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Center for the Study of Traumatic Stress. (2020). Mental Health and Behavioral Guidelines for Preparedness and Response to Coronavirus and other Emerging Infectious Outbreaks.

This fact sheet lists steps that can be taken to minimize stress during several phases of a pandemic (preparedness, early pandemic response, mental health intervention planning, and later response and recovery).

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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2012). Disaster Mental Health Primer: Key Principles, Issues and Questions.

This page illustrates guiding principles for those responding to or otherwise affected by disaster. Visitors can get a better understanding of "The Impact Pyramid" and "The Phases of Disaster," which illustrate impacted populations and emotions often experienced after disaster.

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Centers for Disease Control and Prevention, Emergency Preparedness and Response. (2018). Disaster Mental Health for Responders: Key Principles, Issues and Questions.

This webpage provides a brief overview of guiding principles, disaster survivor needs and reactions, and signs that may indicate the need for mental health treatment referral. A list of "common" stress reactions for responders is also included, as are links to the sources used to create the page.

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Hansen, C. (2014). Integrating Behavioral Health to Strengthen Healthcare Preparedness Capabilities and Coalitions. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.

The speaker in this webinar explains how healthcare coalitions can incorporate behavioral health into their healthcare preparedness capabilities.

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Hodge, J.G., Rutkow, L., and Corcoran, A.J. (2010). Mental and Behavioral Health Legal Preparedness in Major Emergencies. Public Health Reports. 125(5): 759-762.

The authors discuss the importance of preparing to address mental and behavioral health problems in affected populations and emergency responders following a major disaster, both programmatically and legally.

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Johns Hopkins Preparedness and Emergency Response Research Center. (n.d.). Legal and Ethical Assessment Concerning Mental and Behavioral Health Preparedness.

This website contains links to article on various legal and ethical issues, and potential solutions, related to the identification, accommodation, response, and treatment of people with mental and behavioral health conditions before, during, and after emergencies and disasters.

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Johns Hopkins Preparedness and Emergency Response Research Center. (2012). Legal and Ethical Assessment Concerning Mental and Behavioral Health Preparedness. (Accessed 2/3/2020.)

The authors provide links to resources that focus on ethical issues related to disaster behavioral health.

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Johns Hopkins Preparedness and Emergency Response Research Center. (2012). Mental Health Legal Preparedness and Crisis Standard of Care.

This tool was designed to help healthcare providers and their public and private sector partners better understand the Institute of Medicine (IOM) Crisis Standard of Care Report and its recommendations for mental health care in emergencies.

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Johns Hopkins Preparedness and Emergency Response Research Center. (2019). Frequently Asked Questions on Ethical Issues Related to Mental Health Care in Emergencies.

This tool can help healthcare providers and administrators and their public and private sector partners who seek an enhanced understanding of the ethical issues that may arise during and after emergencies relative to mental and behavioral health. Links to additional resources are provided at the end of the document.

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Meredith, L., Eisenman, D., Tanielian, T., et al. (2010). Prioritizing "Psychological" Consequences for Disaster Preparedness and Response: A Framework for Addressing the Emotional, Behavioral, and Cognitive Effects of Patient Surge in Large-Scale Disasters. (Free registration required.) Disaster Medicine and Public Health Preparedness. 4(E1-E8).

The authors share guidance for healthcare facilities on how to manage the psychological aspects of large-scale disasters that might involve a surge of psychological casualties.

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* National Child Traumatic Stress Network. (2014). Pediatric Medical Traumatic Stress Toolkit for Health Care Providers.

This resource consists of a compendium of tools to help providers address the emotional, as well as the physical side of trauma. Included are guidebooks on implementing trauma-informed care, with case studies and examples, as well as complementary patient handouts for children and parents with evidence-based tips and activities.

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New York Disaster Interfaith Services. (2007). NYDIS (New York Disaster Interfaith Services) Manual for New York City Religious Leaders: Spiritual Care and Mental Health for Disaster Response and Recovery.

Healthcare facility-based faith leaders can use the information in this monograph to prepare to provide spiritual and emotional care after disasters and other emergencies.

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Office of the Assistant Secretary for Preparedness and Response. (2021). A Guide to Compassionate and Empathic Dialogue. U.S. Department of Health and Human Services.

ASPR worked with the Americares Foundation, Puerto Rico Region, to develop this guide to help emergency response and recovery personnel engage effectively and empathically with their stakeholders in a multi-hazard environment. It includes an overview of the emotional phases of a disaster, the essential steps of offering compassionate and empathic communication, and supportive evidence-based information and resources. Also available in Spanish: https://files.asprtracie.hhs.gov/documents/guia-para-un-dialogo-compasivo-y-empatico-report.pdf

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Substance Abuse and Mental Health Services Administration. (2003). Developing Cultural Competence in Disaster Mental Health Programs. U.S. Department of Health and Human Services.

These guidelines and recommendations can help emergency medical providers develop culturally competent disaster mental health services. Tips for working with refugees and guidelines for using interpreters are also included.

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U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2018). Prevention After Natural Disasters.

This webinar examines how individuals who experience a natural disaster may be more likely to experience behavioral health issues or misuse substances. Viewers will learn how individuals, organizations, and communities can help promote mental health and prevent substance misuse after these types of events.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2018). Behavioral Health Conditions in Children and Youth Exposed to Natural Disasters.

This resource discusses mental health and substance use (behavioral health) conditions in children and adolescents following exposure to natural disasters such as hurricanes, tornadoes, and earthquakes. It discusses the challenges faced by children and adolescents following natural disasters; sheds light on behavioral health consequences (such as PTSD, depression, and acute stress disorder) of being exposed to traumatic events; and presents various ways to reduce lasting impacts of such events.

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* U.S. Department of Veterans Affairs, National Center for PTSD. (2016). Traumatic Effects of Specific Types of Disasters.

This webpage discusses research findings from specific disasters, such as earthquakes and floods, which show that each type of disaster can have unique consequences.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Reactions Following Disaster and Mass Violence.

This resource discusses how the impact of disaster and mass violence is often widespread, with many people who directly experience the event and many more who witness or are indirectly affected by it. It details responses and interventions for the post-event period, which can be divided into four phases: impact, immediate, intermediate, and long-term.

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Lessons Learned

Abramson, D., Van Alst, D., Merdjanoff, A., et al. (2015). The Hurricane Sandy Person Report: Disaster Exposure, Health Impacts, Economic Burden, and Social Well-Being.

The authors examine the impact of Hurricane Sandy ("the dose") on the health and well-being of New Jersey residents ("the response") exposed to the storm. Primary findings include: the negative effect housing damage had on residents' health is similar to the effect of poverty; some toxins (e.g., mold) had a double negative effect (e.g., clinically-diagnosed asthma and mental health distress); and children living in homes that experienced minor physical damage were more likely to be sad or depressed or having sleeping problems.

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* ASPR TRACIE. (2017). The Exchange: Volume 2, Issue 1.

This issue of the newsletter focuses on disaster behavioral health and resilience from the federal (ASPR ABC, OEM, and EPAP); state (Florida’s response to the Pulse nightclub shooting); local (a responder discusses seeking help after managing a traumatic scene); and general (the authors provide an overview of responder behavioral health and emphasize the importance of top-down support for related programs) perspectives.

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Attfield, K., Dobson, C., Henn, J., et al. (2015). Injuries and Traumatic Psychological Exposures Associated with the South Napa Earthquake — California, 2014. Morbidity and Mortality Weekly Report. 64(35): 975-978..

The authors interviewed residents after the South Napa earthquake and found that many experienced injuries, mental health stressors, or both, in addition to property damage. They emphasize the need for planners to prioritize both mental and physical health assistance in their exercises and plans.

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Augusterfer, E., Mollica, R., and Lavelle, J. (2015). A Review of Telemental Health in International and Post-Disaster Settings. (Abstract only.) International Review of Psychiatry. 27(6):1-7.

This article discusses global mental health needs with a focus on the use of telemental health (TMH) to meet mental health needs in international and post-disaster settings. It also reviews the mental health impact of the Haiti 2010 earthquake and describes the limited use of telemedicine in post-disaster Haiti.

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Beinecke, R.H. (2014). Addressing the Mental Health Needs of Victims and Responders to the Boston Marathon Bombings. (Abstract only.) International Journal of Mental Health. 43(2).

The authors highlight the roles played by the various agencies involved in the mental health response to the Boston Marathon Bombings.

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Brewin, C.R., Fuchkan, N., Huntley, Z., et al. (2010). Outreach and Screening Following the 2005 London Bombings: Usage and Outcomes. Psychological Medicine. 40(12): 2049-2057.

The authors describe the usage of the two-year Trauma Response Program by survivors of the 2005 London bombings. Information on diagnoses and outcomes is included.

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Bromet, E. (2014). Emotional Consequences of Nuclear Power Plant Disasters. Health Physics. 106(2): 206-210.

This article describes the emotional consequences and resilience of two groups of nuclear power plant disaster survivors: mothers of young children and nuclear plant workers. The authors stress the need for considering physical and mental health "in an integrated fashion," the need for more long-term research, and the need for healthcare providers to be able to recognize and manage psychological symptoms.

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Brooks, S., Webster, R., Smith, L., et al. (2020). The Psychological Impact of Quarantine and How to Reduce it: Rapid Review of the Evidence. The Lancet. 395(10227): 912-920.

The authors conducted a literature review to synthesize lessons learned from SARS, Ebola, the 2009 and 2010 H1N1 influenza pandemic, MERS, and equine influenza pandemics. They summarize stressors during quarantine (e.g., fear of infection, frustration and boredom) and after quarantine (e.g., financial hardship and stigma) and list strategies for mitigating negative mental health effects.

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Calderon-Abbo, J. (2008). The Long Road Home: Rebuilding Public Inpatient Psychiatric Services in Post-Katrina New Orleans. Psychiatric Services. 59(3): 304-309.

The author describes the clinical and administrative experiences and lessons learned from providing inpatient care in post-Katrina New Orleans. He covers categories such as the increased demand for programs to treat patients with co-occurring disorders, psychiatrists faced with providing primary care in addition to behavioral healthcare, and staff shortages and staff trauma.

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Cohen Silver, R., Holman, A., McIntosh, D., et al. (2002). Nationwide Longitudinal Study of Psychological Responses to September 11. Journal of the American Medical Association. 288(10): 1235-1244.

The authors share the results from a nationwide sample of 2729 individuals to measure stress related to the 9/11 terrorist attacks.

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Ford, E. (2013). Evacuation of Psychiatric Inpatients from Bellevue Hospital Post Hurricane Sandy. (Note: only available via iTunes.) Psychiatric Times.

In this podcast Dr. Elizabeth Ford discusses her experience during the evacuation of psychiatric patients from Bellevue Hospital in Manhattan in the immediate aftermath of Hurricane Sandy. Sixty-one incarcerated psychiatric patients had to be evacuated from the 19th floor due to flooding and loss of electricity.

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Fukunaga, H., and Kumakawa, H. (2015). Mental Health Crisis in Northeast Fukushima after the 2011 Earthquake, Tsunami and Nuclear Disaster. The Tohoku Journal of Experimental Medicine. 237(1):41-3.

Before the 2011 Fukushima disaster, there were five hospitals and two clinics for psychiatric patients in the district of Soso (northeast Fukushima). Several years later, however, one hospital and three clinics remained (though a new mental health clinic was opened in 2012 in Soma City to support disaster survivors). The authors stress the importance of "mid- and long-term supports...not only for psychiatric patients but also for all residents in the district of Soso."

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Haggerty, E. (2013). When Bellevue Had to Evacuate Its Criminally Insane. Bedford+Bowery.

This article describes Bellevue Hospital’s experience during the evacuation of psychiatric patients after Hurricane Sandy. Sixty-one incarcerated psychiatric patients had to be evacuated from the 19th floor and transported to other facilities. During this evacuation patients were cooperative, which helped with the success of the evacuation.

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Heid, A., Christman, Z., Pruchno, R., et al. (2016). Vulnerable, but Why? Post-traumatic Stress Symptoms in Older Adults Exposed to Hurricane Sandy. (Free registration required.) Disaster Medicine and Public Health Preparedness. 10(3):362-70.

Post-traumatic stress disorder symptoms were much more likely in older adults affected by Hurricane Sandy who had lower levels of income, positive affect, employment, and other factors that may allow for targeted interventions to increase pre-event resilience and promote post-event recovery.

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Johnson, K. (2012). School Shootings and Lessons Learned. (Free registration required.) Medscape Medical News.

The authors explain that the behavioral health consequences experienced by survivors of the 2006 Dawson College shooting surpassed posttraumatic stress disorder and included substance abuse and major depressive disorder. Nearly 100 mental health professionals provided support including the daily use of 12 therapy rooms for over 6 months.

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Kim, T.J., Arrieta, M.I., Eastburn S.L., et al. (2013). Post-disaster Gulf Coast Recovery Using Telehealth. Telemedicine Journal and E-Health. 19(3):200-10.

The authors, whose work focuses on telemedicine to meet post-disaster mental health needs, conducted semi structured interviews with both regional key informants and national organizations with Gulf Coast recovery interests and determined seven factors for telehealth success: funding, regulatory, workflow, attitudes, personnel, technology, and evaluation. Included in this resource is also a discussion of prior research conducted on the use of telemental health services.

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King, M., Schreiber, M., Formanski, S., et al. (2013). A Brief Report of Surveillance of Traumatic Experiences and Exposures After the Earthquake-Tsunami in American Samoa, 2009. (Free registration required.) Emergency Medicine Journal. 26(12):899-902. 7(3):327-31.

The authors conducted a cross-sectional, comparative review of mental health triage data from survivors of the September 2009 earthquake-tsunami in American Samoa. More than 90% of survivors referred for mental health services reported that they "felt extreme panic/fear" "felt direct threat to life." The authors commend the utility of the combination of evidence-based mental health triage and community assessment.

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Liu, J., Potter, S., Athens, B., et al. (2015). Behavioral Health Response to Ebola. Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center.

This webinar provides details regarding the 2014 Ebola outbreak in Dallas, Texas and the speakers share behavioral health-specific lessons learned.

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Lowe, S. and Galea, S. (2017). The Mental Health Consequences of Mass Shootings. Trauma, Violence, and Abuse. 18(1): 62-82.

The authors conducted a literature review and found several variables associated with negative mental health effects related to mass shooting incidents: "demographic and pre-incident characteristics (e.g., female gender and pre-incident psychological symptoms), event exposure (e.g., greater proximity to the attack and acquaintance with the deceased), and fewer psychosocial resources (e.g., emotion regulation difficulties and lower social support)." They emphasize the need for more research that can inform preparedness and post-incident interventions.

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* McCarroll, J., Vineburgh, N., and Ursano, R. (Eds.). (2013). Disaster, Disease and Distress: Resources to Promote Psychological Health and Resilience in Military and Civilian Communities. Center for the Study of Traumatic Stress, Uniformed Services University.

This is a compilation of 10 years’ worth of Center fact sheets on military and disaster health and mental health topics. It is geared towards healthcare providers, government and military leadership, service members, families, and communities and raises awareness of and shares strategies for coping with traumatic exposure.

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Nemethy, A. (2011). At Vermont State Hospital after Irene, Drama--and Many Questions. VTDigger.org.

This article discusses the evacuation of 51 psychiatric patients from Vermont State Hospital after Hurricane Irene. The experience was described as an "orderly chaos" as patients were evacuated and transported to other facilities.

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* Nordanger, D.O., Breivik, K., Storm Haugland, B., et al. (2014). Prior Adversities Predict Posttraumatic Stress Reactions in Adolescents Following the Oslo Terror Events 2011. European Journal of Psychotraumatology. 5: 10.3402/ejpt.v5.23159.

The authors studied the relationship between prior exposure to traumatic experiences (e.g., violence or sexual abuse) and the development of posttraumatic stress reactions after the 2011 Oslo Terror events.

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Norris, F., Friedman, M., Watson, P., et al. (2002). 60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981-2001. Psychiatry. 65(3):207-39.

The authors of this landmark paper examined 160 samples of disaster victims and coded their experiences by sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. The most frequently mentioned results by the survivors were psychological problems, nonspecific distress, and health problems.

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Resnick, L. (2014). It Takes a Team: The 2013 Boston Marathon: Preparing for and Recovering from a Mass-Casualty Event. (Registration required to download the free PDF.) The Journal of Bone & Joint Surgery.

This special report from the Journal of Bone & Joint Surgery and the Journal of Orthopaedic & Sports Physical Therapy describes the emergency medical response and "the arduous lifelong recovery" facing survivors. Chapter 9 provides an overview of some of the community and hospital mental health services provided with specific details about the assessments and support offered.

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Siqveland, J., Nygaard, E., Hussain, A., et al. (2015). Posttraumatic Growth, Depression and Posttraumatic Stress in Relation to Quality of Life in Tsunami Survivors: A Longitudinal Study. Health and Quality of Life Outcomes. 13:18.

Almost 60 Norwegian adults who survived the 2004 Southeast Asia Tsunami completed questionnaires two and six years after the disaster. The authors examine the effect of post-traumatic stress and growth on quality of life.

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Spencer, C. (2015). Having and Fighting Ebola Public Health Lessons from a Clinician Turned Patient. The New England Journal of Medicine. 372:1089-1091.

Dr. Craig Spencer describes his experience treating Ebola patients in Guinea (and the effects the work had on his behavioral health). He also highlights his experience as a patient, and emphasizes the role that "irrational fear" had on the response to the disease.

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Tanisho, Y., Smith, A., Sodeoka, T., and Murakami, H. (2015). Post-Disaster Mental Health in Japan: Lessons and Challenges. Health and Global Policy Institute.

This report describes lessons learned from the Fukushima nuclear disaster in 2012. It includes recommendations for ensuring that psychosocial and mental health interventions consider the unique circumstances and cultural issues of a given disaster.

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* Thienkrua, W, Lopes Cardozo, B., Chakkraband, S., et al. (2006). Symptoms of Posttraumatic Stress Disorder and Depression Among Children in Tsunami-Affected Areas in Southern Thailand. (Abstract only.) Journal of the American Medical Association. 296(5):549-559.

The authors reviewed survey data from 371 children affected by the tsunami and discuss prevalence rates of posttraumatic stress disorder and depression. A follow-up survey found that these rates did not decrease significantly over time.

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* U.S. Department of Veterans Affairs, National Center for PTSD. (2016). Traumatic Effects of Specific Types of Disasters.

This webpage discusses research findings from specific disasters, such as earthquakes and floods, which show that each type of disaster can have unique consequences.

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Usami, M., Iwadare, Y., Watanabe, K., et al. (2014). Decrease in the Traumatic Symptoms Observed in Child Survivors within Three Years of the 2011 Japan Earthquake and Tsunami. PLoS One. 9(10).

The authors studied in traumatic symptoms experienced by pediatric survivors of the 2011 Japan earthquake and tsunami 8, 20, and 30 months after the event. They found that while most negative effects decreased over time in this population, post-traumatic stress disorder and depressive symptoms did not improve consistently.

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Wang, P., Gruber, M., Powers, R., et al. (2007). Mental Health Service Use Among Hurricane Katrina Survivors in the Eight Months After the Disaster. Psychiatric Services. 58(11): 1403-1411.

The authors examined use of mental health services by adult Hurricane Katrina survivors. They found that barriers (e.g., financial, attitudes towards treatment) kept some with serious mood or anxiety disorders from seeking treatment.

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World Health Organization. (2013). Building Back Better Sustainable Mental Health Care after Emergencies. (Available in several languages.)

The World Health Organization presents ten international case studies to highlight how stakeholders built high- quality and sustainable mental health systems in the face of challenging circumstances.

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Yabuki, S., Ouchi, K., Kikuchi, S., and Konno, S. (2015). Pain, Quality of Life and Activity in Aged Evacuees Living in Temporary Housing after the Great East Japan Earthquake of 11 March 2011: A Cross-Sectional Study in Minamisoma City, Fukushima Prefecture. BMC Musculoskeletal Disorders. 16:246.

The authors surveyed 71 older evacuees and found significantly lower quality-of-life scores (compared to the national average) for the following subscales: “physical functioning,” “role physical,” “general health,” “social functioning,” “role emotional,” and “mental health.” The authors emphasize the importance of treating both physical and emotional effects experienced by disaster survivors.

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Yusuf, H., Taioli, E., and Gwynn, C. (2015). Weathering the Storm: Understanding the Mental Health Impact of Hurricane Sandy. Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response.

In this conference call, the speakers discuss mental health issues and Hurricane Sandy. They also highlighted how these findings could be incorporated into disaster preparedness and response activities and how healthcare providers can help address mental health challenges in disaster survivors.

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Plans, Tools, and Templates

* Acosta, J., Faherty, L., Landis, R., et al. (2023). Monitoring and Surveillance of Behavioral Health in the Context of Public Health Emergencies: A Toolkit for Public Health Officials. RAND Corporation.

This interactive toolkit can help state, territorial, local, and tribal public health use existing data sources (e.g., unemployment insurance claims, hotline calls, calls to Poison Control Centers, 9-8-8 calls, and use of emergency medical services) during public health emergencies while the development of longer-term data collection efforts are in process.

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California Health and Human Services Agency. (2012). State of California Mental/Behavioral Health Disaster Framework.

This framework document provides a statewide approach to the mental/behavioral health disaster function and can help government and other agencies and organizations develop, revise, and implement their own mental/behavioral health disaster policies, plans and procedures.

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California Public Health and Medical Emergency Operations Manual (EOM) Workgroup. (2018). Resource Typing Guidance: Disaster Mental/Behavioral Health and Spiritual Care.

These resource typing tools provide information on the types of disaster behavioral health resources--including numbers and ratios--that can support certain disaster missions. The second tool provides information regarding the types of personnel that may be suitable for deployment. While specific to the State of California, these tools can be tailored by other state planners.

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California Public Health and Medical Emergency Operations Manual (EOM) Workgroup. (2020). California Disaster Behavioral Health Plan.

This plan provides disaster behavioral health information for behavioral health agencies and providers, emergency managers, and all who manage the behavioral health impacts of disasters that affect California.

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City of New York, Department of Health and Mental Hygiene. (2013). Heat Wave Preparedness Checklists for Mental Health Service Providers.

These checklists can help mental health service providers identify consumers and residents at highest risk for heat-related illnesses.

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Compton, M., Kotwicki, R., Kaslow, N., et al. (2005). Incorporating Mental Health into Bioterrorism Response Planning. Public Health Reports. 120(Suppl 1): 16-19.

The authors discuss the special issues related to bioterrorism response planning, including "negative emotional/psychological reactions." They lists steps for protecting and promoting mental health in the community and include an action model for a mental health response to a bioterrorism event.

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DC Emergency Healthcare Coalition. (2014). DCEHC Disaster Behavioral Health Planning Template.

This template provides planning guidance that allows healthcare facilities prepare for and respond to the behavioral health needs of patients, staff, and loved ones impacted by a disaster or other emergent situation.

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Federal Emergency Management Agency. (2015). Crisis Counseling Assistance & Training Program.

The mission of this program is to help individuals and communities recover from the behavioral health effects of natural and human-caused disasters by providing community-based outreach and psycho-educational services. Supplemental funding for crisis counseling is available to State Mental Health Authorities through two grant mechanisms: the Immediate Services Program (ISP; funds for up to 60 days of services immediately following a disaster declaration); and the Regular Services Program (RSP; funds for up to nine months following a disaster declaration). FEMA monitors ISP, and SAMHSA provides technical assistance. SAMHSA monitors all RSP programs.

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Nikki Bellamy The statement regarding the monitoring of the RSP and ISP is incorrect. See FEMA's website for the correct distinction https://www.fema.gov/recovery-directorate/crisis-counseling-assistance-training-program.
9/9/2016 11:14:20 AM

Laraque, D., Jensen, P., and Schonfeld, D.J. (2006). Feelings Need Check-ups Too Toolkit. American Academy of Pediatrics.

This toolkit can help practitioners intervene effectively with children experiencing emotional distress related to catastrophic events. Various screening tools are demonstrated through case studies, and treatment options are described, along with information on accessing mental health resources for treatment referrals.

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Los Angeles County Office of Emergency Management and Los Angeles County Department of Mental Health. (2014). Los Angeles County Operational Area Family Assistance Center Plan (Contact ASPR TRACIE to access this file.).

This plan provides a framework for the activation, operation, management, and demobilization of a County Operational Area (government-led) family assistance center (FAC) during large scale mass casualty incidents (e.g., earthquakes) and local incidents such as shootings and explosions. The establishment of a FAC can: ensure a place for loved ones to gather information; serve as a coordination spot for first responders; and be a location where emotional support and other types of health support can be provided. (The Los Angeles County Operational Area covers all 88 cities and the unincorporated areas in the county.)

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Mississippi State Department of Health. (2018). Community Mental Health Center Emergency Operations Plan Template.

This template may be used to develop an Emergency Operations Plan for a Community Mental Health Center. In addition to the all hazards base plan, the template includes incident-specific annexes.

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Missouri Department of Mental Health. (2013). The Behavioral Health Emergency Plan Template for Health Care Organizations.

This template was developed to assist hospitals and health care providers in integrating behavioral/mental health functions into their emergency plans. This document can serve as a template/checklist.

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National Association of State Mental Health Program Directors and National Technical Assistance Center for State Mental Health Planning. (2003). Mental Health All-Hazards Disaster Planning Guidance. Substance Abuse and Mental Health Services Administration.

This is an instructional guide and template for state disaster mental health planners.

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* National Child Traumatic Stress Network. (2014). Pediatric Medical Traumatic Stress Toolkit for Health Care Providers.

This resource consists of a compendium of tools to help providers address the emotional, as well as the physical side of trauma. Included are guidebooks on implementing trauma-informed care, with case studies and examples, as well as complementary patient handouts for children and parents with evidence-based tips and activities.

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Office of the Assistant Secretary for Preparedness and Response. (2021). A Guide to Compassionate and Empathic Dialogue--Quick Reference Guide to Possible Scenarios. U.S. Department of Health and Human Services.

This flashcard can be used by call takers or those visiting with disaster survivors in person. It includes prompts for four specific situations: common conversations, conversation with vulnerable population members, conversations with a person in crisis, and conversation with a person at risk or in danger. This flashcard is based on the information found in the longer guide: https://files.asprtracie.hhs.gov/documents/guide-compassionate--and-empathic-dialogue-508.pdf. Also available in Spanish: https://files.asprtracie.hhs.gov/documents/flash-card-guia-para-un-dialogo-compasivo-y-empatico.pdf

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Schreiber, M. (2011). National Children’s Disaster Mental Health Concept of Operations. Terrorism and Disaster Center at the University of Oklahoma Health Sciences Center.

This document outlines an evidence-based, triage-enhanced children’s disaster mental health incident response strategy designed to be used in any community. The author matched the continuum of risk to a corresponding continuum of care and emphasizes the importance of an integrated response.

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* Substance Abuse and Mental Health Services Administration. (2013). Disaster Planning Handbook for Behavioral Health Treatment Programs: Technical Assistance Publication (TAP) Series 34. U.S. Department of Health and Human Services.

The information in this handbook can help behavioral health treatment program staff plan (or enhance existing plans) for all types of disasters. The guide includes informative chapters and templates that can be customized or used as is by program staff.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2015). Disaster Behavioral Health Interventions Inventory.

This Supplemental Research Bulletin is an inventory of primarily disaster-specific interventions, although several may also be used to assist people who are suffering with distress or disorders associated with other types of traumatic events.

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Plans, Tools, and Templates: Apps and Internet-Based Interventions

* Acosta, J., Faherty, L., Landis, R., et al. (2023). Monitoring and Surveillance of Behavioral Health in the Context of Public Health Emergencies: A Toolkit for Public Health Officials. RAND Corporation.

This interactive toolkit can help state, territorial, local, and tribal public health use existing data sources (e.g., unemployment insurance claims, hotline calls, calls to Poison Control Centers, 9-8-8 calls, and use of emergency medical services) during public health emergencies while the development of longer-term data collection efforts are in process.

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* Lewis, C., Roberts, N., Bethell, A., et al. (2018). Internet-Based Cognitive and Behavioural Therapies for Post-Traumatic Stress Disorder (PTSD) in Adults. Cochrane Database of Systematic Reviews.

This review was conducted to assess the effects of Internet-based cognitive and behavioral therapy (I-C/BT), and included 10 studies with 720 participants: 8 of the studies compared I‐C/BT delivered with therapist guidance to a wait list control; 2 studies compared guided I‐C/BT with I‐non‐C/BT. The authors found some beneficial effects of I-C/BT for PTSD, but note that the quality of the evidence is low due to the small number of included studies.

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National Child Traumatic Stress Network. (2013). PFA Mobile™.

This mobile app can help responders who provide Psychological First Aid (PFA). It features a review of the core functions of PFA, helps users match interventions to survivors' reactions, provides mentoring tips, helps users assess their readiness to conduct PFA, and helps track survivors' needs.

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Ruggiero, K., Price, M., Adams, Z. et al. (2015). Web Intervention for Adolescents Affected by Disaster: Population-Based Randomized Controlled Trial. Journal of the American Academy of Child and Adolescent Psychiatry. 54(9): 709–717.

This article discusses a population-based randomized controlled trial conducted to assess the efficacy of Bounce Back Now (BBN), a modular, web-based intervention for disaster-affected adolescents and their parents. The authors concluded that, “results supported the feasibility and initial efficacy of BBN as a scalable disaster mental health intervention for adolescents.”

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (2014). SAMHSA Behavioral Health Disaster Response Mobile App.

This app provides first responders access to field resources for aiding disaster survivors, and the ability to search for and map behavioral health service providers in the impacted area, review emergency preparedness materials, and share resources.

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* U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Mobile App: PTSD (Post-Traumatic Stress Disorder) Coach.

The PTSD (Post-Traumatic Stress Disorder) Coach app can help users learn about and manage symptoms that often occur after trauma. Features include reliable information on PTSD and treatments that work; tools for screening and tracking symptoms; convenient, easy-to-use tools to help handle stress symptoms; and direct links to support and help.

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* U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Mobile App: PTSD (Post-Traumatic Stress Disorder) Family Coach.

The Mobile App: PTSD (Post-Traumatic Stress Disorder) Family Coach app can help concerned family members of those with PTSD learn about PTSD, how to take care of themselves, and how to manage their relationships with their affected loved one or children. Note: app users can change the language from English to Spanish once they download the content.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2019). Mobile Apps.

This webpage includes links to mobile apps that can provide self-help, education and support following trauma. There are also treatment companion apps, for use with a health care provider, to make treatment easier.

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Posttraumatic Stress Disorder

Alabama Department of Public Health. (2015). Post-Traumatic Stress Disorder Following All Hazards Disasters.

This 90-minute webinar provides an overview of post-traumatic stress disorder (PTSD) following all hazards disasters. Speakers identify the signs and symptoms of PTSD, intervention strategies and treatment options.

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Benedek, D.M., and Wynn, G.H. (2011). Clinical Manual for Management of PTSD. (Book available for purchase.)

This book, geared towards clinicians, residents, and students, highlights post-traumatic stress disorder and how it manifests and can be treated.

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Berger, R., Gelkopf, M., and Heineberg, Y. (2012). A Teacher-Delivered Intervention for Adolescents Exposed to Ongoing and Intense Traumatic War-Related Stress: A Quasi-Randomized Controlled Study. (Abstract only.) Journal of Adolescent Health. 51(5): 453-461.

The authors of this study evaluate posttraumatic symptomatology in a sample of seventh- and eighth-grade students from Sderot, a town in Israel which faces near-constant threat of shelling and mortar attacks. They found efficacy of a teacher-delivered intervention in preventing and reducing adolescents' related symptoms. This may have applications for children that are displaced or exposed to continued ongoing stressors.

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* Lewis, C., Roberts, N., Bethell, A., et al. (2018). Internet-Based Cognitive and Behavioural Therapies for Post-Traumatic Stress Disorder (PTSD) in Adults. Cochrane Database of Systematic Reviews.

This review was conducted to assess the effects of Internet-based cognitive and behavioral therapy (I-C/BT), and included 10 studies with 720 participants: 8 of the studies compared I‐C/BT delivered with therapist guidance to a wait list control; 2 studies compared guided I‐C/BT with I‐non‐C/BT. The authors found some beneficial effects of I-C/BT for PTSD, but note that the quality of the evidence is low due to the small number of included studies.

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* Nordanger, D.O., Breivik, K., Storm Haugland, B., et al. (2014). Prior Adversities Predict Posttraumatic Stress Reactions in Adolescents Following the Oslo Terror Events 2011. European Journal of Psychotraumatology. 5: 10.3402/ejpt.v5.23159.

The authors studied the relationship between prior exposure to traumatic experiences (e.g., violence or sexual abuse) and the development of posttraumatic stress reactions after the 2011 Oslo Terror events.

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Pietrzak, R.H., Feder, A., Singh, R., et al. (2014). Trajectories of PTSD Risk and Resilience in World Trade Center Responders: An 8 Year Prospective Cohort Study. Psychological Medicine. 44(1): 205-219.

The authors studied the factors associated with posttraumatic stress disorder (PTSD) symptoms in World Trade Center first responders. They found that prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions had the strongest relationships with PTSD; greater levels of education and family and work support were protective factors.

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Seahorn, J. (2016). Understanding PTSD's Effects on Brain, Body, and Emotions. Colorado State University.

This TED talk reviews PTSD’s effects on the brain, body, and emotions. The presenter incorporates stories to illustrate key points.

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Seppala, E., Nitschke, E., Tudorascu, D., et al. (2014). Breathing-Based Meditation Decreases Posttraumatic Stress Disorder Symptoms in U.S. Military Veterans: A Randomized Controlled Longitudinal Study. Journal of Traumatic Stress. 27: 397-405.

The authors studied the effect of meditation-based interventions on veterans with posttraumatic stress disorder. They found that those in the "active" group reported better results than participants in the control group.

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Shalev, A., Ankri, Y., Israeli-Shalev, Y., et al. (2012). Prevention of Posttraumatic Stress Disorder by Early Treatment. Journal of the American Medical Association. 69(2):166-176.

The authors studied the role of prolonged exposure (PE), cognitive therapy, and delayed PE on traumatic event survivor posttraumatic stress disorder.

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Spoont, M.R., Williams, Jr., J.W., Kehle-Forbes, S., et al. (2015). Does This Patient Have Posttraumatic Stress Disorder? Rational Clinical Examination Systematic Review. Journal of the American Medical Association. 314(5):501-510.

The authors reviewed studies of screening instruments for post-traumatic stress disorder (PTSD) that used gold standard structured clinical diagnostic interviews and had interview samples of at least 50 individuals. They found that two screening instruments, PC-PTSD and the PTSD Checklist, were easy to administer and demonstrated "reasonable performance characteristics for use in primary care clinics or in community settings."

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* Thienkrua, W, Lopes Cardozo, B., Chakkraband, S., et al. (2006). Symptoms of Posttraumatic Stress Disorder and Depression Among Children in Tsunami-Affected Areas in Southern Thailand. (Abstract only.) Journal of the American Medical Association. 296(5):549-559.

The authors reviewed survey data from 371 children affected by the tsunami and discuss prevalence rates of posttraumatic stress disorder and depression. A follow-up survey found that these rates did not decrease significantly over time.

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Thoresen, S., Jensen, T.K., and Dyb, G. (2014). Media Participation and Mental Health in Terrorist Attack Survivors. Journal of Traumatic Stress. 27(6):639-646.

The authors examined the relationship between positive and negative experiences with media and posttraumatic stress reactions among survivors of the 2011 Utøya Island terrorist attack in Norway.

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U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). About PTSDPubs. (Accessed 4/8/2019.)

This bibliographic database, sponsored by the U.S. Department of Veterans Affairs, is a freely available, online database providing access to the worldwide literature on PTSD and other mental health consequences of exposure to traumatic events.

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* U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Mobile App: PTSD (Post-Traumatic Stress Disorder) Coach.

The PTSD (Post-Traumatic Stress Disorder) Coach app can help users learn about and manage symptoms that often occur after trauma. Features include reliable information on PTSD and treatments that work; tools for screening and tracking symptoms; convenient, easy-to-use tools to help handle stress symptoms; and direct links to support and help.

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* U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Mobile App: PTSD (Post-Traumatic Stress Disorder) Family Coach.

The Mobile App: PTSD (Post-Traumatic Stress Disorder) Family Coach app can help concerned family members of those with PTSD learn about PTSD, how to take care of themselves, and how to manage their relationships with their affected loved one or children. Note: app users can change the language from English to Spanish once they download the content.

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Resilience Resources

Acosta, J., Chandra, A., and Madrigano, J. (2017). An Agenda to Advance Integrative Resilience Research and Practice. RAND.

The authors examine community resilience in the face of increasing disasters, emergencies, and other traumatic events. They provide a list of recommendations community and emergency planners can consider to bolster resilience.

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Arnberg, F., and Melin, L. (2013). Can Demographic and Exposure Characteristics Predict Levels of Social Support in Survivors from a Natural Disaster? PLoS One. 8(6):e65709.

The authors examined if certain demographic characteristics (e.g., age, gender, disaster exposure severity) could predict types of informal social support in a cohort of Swedish survivors of the 2004 Southeast Asian tsunami.

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* ASPR TRACIE. (2017). The Exchange: Volume 2, Issue 1.

This issue of the newsletter focuses on disaster behavioral health and resilience from the federal (ASPR ABC, OEM, and EPAP); state (Florida’s response to the Pulse nightclub shooting); local (a responder discusses seeking help after managing a traumatic scene); and general (the authors provide an overview of responder behavioral health and emphasize the importance of top-down support for related programs) perspectives.

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Bonanno, G.A., Pat-Horenczyk, R., and Noll, J. (2012). Coping Flexibility and Trauma: The Perceived Ability to Cope With Trauma (PACT) Scale. Psychological Trauma: Theory, Research, Practice, and Policy. 3(2): 117-129.

This article describes the development and validation of the Perceived Ability to Cope With Trauma (PACT) scale and associated scales that, in part, represent the ability to process and move beyond trauma. The authors studied a sample of Israeli students sample with a higher potential of being exposed to trauma and a sample of American college students.

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Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services, Board on Health Sciences Policy, and Institute of Medicine. (2015). Chapter 7: Behavioral Health. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery.

The authors of this chapter present an overview of the relationship between behavioral health, resilience, and healthy communities; highlights strategies for mitigating negative behavioral health effects in disaster survivors; lists some gaps in addressing disaster-related behavioral health needs; and discusses opportunities for bolstering the behavioral health sector and improving integration with other sectors.

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Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC). (2015). Individual Resilience. U.S. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response.

This factsheet explains resilience and how it contributes to disaster preparedness and response and community resilience.

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Joyce, S., Shand, F., Tighe, J., et al. (2018). Road to Resilience: A Systematic Review and Meta-Analysis of Resilience Training Programmes and Interventions. BMJ Open. 8:e017858.

The authors conducted a meta-analysis of the available evidence on interventions designed to improve individual resilience. From their analysis of 11 randomized controlled studies, they concluded that, “resilience interventions based on a combination of CBT and mindfulness techniques appear to have a positive impact on individual resilience.”

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Norris, F. (2010). Behavioral Science Perspectives on Resilience. Community and Regional Resilience Institute, Oak Ridge National Laboratory.

This research study and literature review summarizes findings pertaining to individual and community resilience. The author provides an overview of resilience (including frameworks and concepts); highlights how individuals perceive and reduce risk; shares how individuals react to and cope with stress; and discusses implications related to behavioral science.

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Southwick, S., Bonanno, G., Masten, A., et al. (2014). Resilience Definitions, Theory, and Challenges: Interdisciplinary Perspectives. European Journal of Psychotraumatology. 5:10.3402.

In this paper, a multidisciplinary panel of experts discusses: how to define resilience; the most important determinants of resilience; how new technologies are informing the science of resilience; and what the most effective ways to enhance resilience are.

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* U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2019). Disaster Behavioral Health Preparedness and Response Resources: Resources for Resilient Individuals and Communities.

This webpage lists disaster preparedness and recovery resources for professionals in the disaster behavioral health field.

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Resources for Responders and Providers

Adams, Z.W., Danielson, C.K., Sumner, J.A., et al. (2015). Comorbidity of PTSD, Major Depression, and Substance Use Disorder Among Adolescent Victims of the Spring 2011 Tornadoes in Alabama and Joplin, Missouri. Psychiatry. 78(2):170-85.

The authors sampled a group of adolescents after the 2011 Joplin, Missouri tornadoes to determine the prevalence of negative emotional consequences and risk factors for those affected by the disaster. The authors highlight their findings and list screening variables that healthcare providers should consider to identify at-risk adolescents after a disaster.

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Agency for Toxic Substances and Disease Registry. (2016). Helping Families Deal with the Stress of Relocation After a Disaster.

This document provides information and tips for healthcare professionals about helping families deal with relocation after a disaster. It provides basic information about stress; signs of and ways to help family members deal with relocation stress; signs of stress in young people of different age groups, from preschool to high school age; ways to help young people deal with stress, from preschool to high school age; how to help the elderly deal with relocation stress; and where to find further information on these topics.

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American Psychiatric Association. (2020). Telepsychiatry Toolkit. (Accessed 4/17/2020.)

This webpage provide links to information and trainings for providing telepsychiatry services.

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* ASPR TRACIE. (2024). Disaster Behavioral Health: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response.

When disasters strike, the ripple effects can be significant. Incorporating disaster behavioral health (DBH) into all phases of emergency management can ensure resident and responder preparedness, an effective, compassionate response effort, and a more resilient community moving forward. This document provides information on and links to select DBH programs and resources that can be of immediate use to emergency health care providers, emergency management stakeholders, and other professionals and survivors affected by naturally occurring or human-caused incidents.

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* Berkowitz, S., Bryant, R., Brymer, M., et al. (2010). Skills for Psychological Recovery: Field Operations Guide. National Center for PTSD and National Child Traumatic Stress Network.

This manual can help disaster behavioral health responders learn about how to help survivors cope with stress and other negative effects after a disaster. This intervention is designed to follow Psychological First Aid support and provides skill-based interventions to the affected individual; links to related resources are provided.

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Bisson, J., Tavakoly, B., Witteveen, A., et al. (2010). TENTS Guidelines: Development of Post-DisasterPsychosocial Care Guidelines through a Delphi Process. The British Journal of Psychiatry. 196(1):69-74.

European trauma experts participated in a survey to develop consensus guidelines related to post-disaster psychosocial care. The authors list the guidelines in an appendix and emphasize the need to train responders in psychosocial aspects of disaster response.

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Call, J.A., Pfefferbaum, B., Jenuwine, M.J., and Flynn, B.W. (2012). Practical Legal and Ethical Considerations for the Provision of Acute Disaster Mental Health Services. Psychiatry. 75(4):305-22.

This article can help emergency healthcare providers learn more about legal and ethical factors associated with providing disaster mental health services.

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Center for the Study of Traumatic Stress. (2020). COVID-19 Pandemic Response Resources.

This webpage includes links to various fact sheets on identifying and managing effect of coronavirus and mental health.

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Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences. (2017). Psychological and Behavioral Issues Healthcare Providers Need to Know When Managing a Chemical, Biological, Radiological or Nuclear (CBRN) Event.

This document discusses the management of acute psychological and behavioral responses following widespread exposure to a chemical, biological, radiological, or nuclear (CBRN) event, which will be as important as the treatment of any CBRN-related injuries and illnesses. It provides guidance on administering psychological first aid, health care, patient education, public health, and mental health.

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Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences. (2017). Psychosocial Concerns After Hurricane Harvey: Tips for Health Care Providers.

This one-page document provided guidance for healthcare providers who mobilized to help communities following Hurricane Harvey. It notes the importance of being mindful of the losses experienced by the population responders will assist, and discusses psychological first aid.

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* Centers for Disease Control and Prevention. (2018). Coping With a Disaster or Traumatic Event.

This webpage contains links to resources focused on disaster behavioral health. There are resources geared towards individuals, responders, health professionals, and other community members, and some are categorized by hazard. The “Responders: Tips for Taking Care of Yourself” page includes discussion on burnout and self-care techniques.

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Centers for Disease Control and Prevention, Center for Preparedness and Response. (2017). Primary Care Providers' Role in Supporting Children, Families, and Professional Self-Care Following Hurricanes and Other Disasters.

This webpage provides information about a webinar that describes the importance of psychological first aid and basic supportive services in promoting adjustment after a disaster. Presenters outline the common symptoms and trajectories of adjustment reactions in children and adolescents; identify strategies to support children, adolescents, and families in healing and recovery after a disaster or crisis situation; and discuss the importance of professional self-care that clinicians can use to promote wellness for themselves and colleagues.

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City of New York, Department of Health and Mental Hygiene. (2018). Providing Psychological First Aid (PFA).

This fact sheet summarizes how psychological first aid (PFA) should be applied during and in the immediate aftermath of disasters to promote safety, calm, connectedness, hope, and self-efficacy. It describes what PFA is and is not, and who should get PFA training.

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Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC). (n.d.). Disaster Behavioral Health. (Accessed 5/7/2019.) U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response.

This factsheet defines disaster behavioral health, explains concerns that can affect both responders and survivors, and explains the role of disaster behavioral health responders.

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Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC). (2012). Behavioral Health Tips for Responders: Maintaining Calm at a POD. U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response.

This factsheet lists assumptions about the environment surrounding points of dispensing and tips for responders on actions to take and messages to convey to community members while on scene.

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Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC). (2012). Disaster Response for Homeless Individuals and Families: A Trauma-Informed Approach. U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response.

This factsheet includes tips for responders when disaster planning for people experiencing homelessness and families. Responders are encouraged to incorporate a trauma-informed approach (i.e., recognize that many members of the population have high rates of past trauma) when planning and responding. Links to additional resources are provided.

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Farchi, M., Levy, T., Ben Gershon, B., et al. (2018). The SIX Cs Model for Immediate Cognitive Psychological First Aid: From Helplessness to Active Efficient Coping. International Journal of Emergency Mental Health and Human Resilience. 20(2): 1-12.

This paper discusses the SIX Cs (i.e., cognitive communication, challenge, control, commitment and continuity) model for immediate cognitive-functional psychological first aid, the national psychological first aid model used by Israel. It may be implemented by lay persons, as well as professionals “to help shift the person from helplessness & passiveness into active effective functioning, within minutes, in the immediate aftermath of a perceived traumatic event.”

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Freedy, J., and Simpson, W. (2007). Disaster-Related Physical and Mental Health: A Role for the Family Physician. American Family Physician. 75(6): 841-846.

The authors encourage family physicians to educate themselves about disaster-related physical and mental health threats, and list common health outcomes under both domains. They emphasize the need for primary care providers to be able to anticipate increased resource use and screen for mental health impacts in their affected patients for a long time after the initial event.

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John Hopkins Public Health Preparedness Programs, and the Arizona State University Sandra Day O’Connor College of Law. (2012). Issue Brief: Substance Abuse Treatment, Emergencies, and the Law.

This tool is intended as a resource for healthcare providers and administrators, public health officials, emergency planners, clergy, and their public and private sector partners who seek to identify key legal issues that may arise during and after emergencies related to substance abuse treatment. This tool provides general information and is not intended to offer jurisdiction-specific guidance. The content focuses primarily on relevant federal laws although select state or local laws may also be discussed.

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Maryville University. (n.d.). What Is Grief Counseling? Techniques and How It Helps. (Accessed 8/8/2022.)

This webpage provides an overview of grief, defines grief counseling (and by age groups), and includes links to related resources.

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* McCarroll, J., Vineburgh, N., and Ursano, R. (Eds.). (2013). Disaster, Disease and Distress: Resources to Promote Psychological Health and Resilience in Military and Civilian Communities. Center for the Study of Traumatic Stress, Uniformed Services University.

This is a compilation of 10 years’ worth of Center fact sheets on military and disaster health and mental health topics. It is geared towards healthcare providers, government and military leadership, service members, families, and communities and raises awareness of and shares strategies for coping with traumatic exposure.

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* National Association of County and City Health Officials. (2016). Behavioral Health Videos.

This resource provides a series of seven behavioral health videos, available in English, Spanish, and American Sign Language. Video 2 is focused on stress management tips for first responders.

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National Child Traumatic Stress Network. (2006). Psychological First Aid – Field Operations Guide.

This guide can help responders use Psychological First Aid "to assist children, adolescents, adults, and families in the aftermath of disaster and terrorism." It includes information about the eight core actions and related handouts for various audiences. (This guide was translated into Simple Chinese in 2020: https://www.nctsn.org/sites/default/files/resources/pfa_field_operations_guide_ch.pdf)

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* National Child Traumatic Stress Network. (2009). Psychological First Aid Online.

This online course can help disaster responders learn about psychological first aid and includes mentor tips, activities, and video demonstrations. Links to related resources and a Learning Community are included.

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National Child Traumatic Stress Network. (2013). PFA (Psychological First Aid) Mobile.

This app was designed to help responders provide Psychological First Aid to disaster survivors. It includes tips for different groups (adults, children, families) and links to other related resources.

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National Institute of Mental Health. (2002). Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/ Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices. NIH Publication No. 02-5138. U.S. Government Printing Office.

Nearly 60 experts in disaster mental health met to examine research on the psychological interventions that are often the first responses to incidents of mass violence. Participants came to consensus in seven areas (e.g., early intervention, timing of early intervention, screening survivors, and follow up); additional helpful information can be found in the appendices.

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National Voluntary Agencies Active in Disasters. (2015). Disaster Emotional Care Points of Consensus.

This document presents consensus guidelines specific to disaster emotional care that have been adopted by the National Voluntary Agencies Active in Disasters (NVOAD). All NVOAD members must abide by these points in order to belong to the coalition.

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Pfefferbaum, B. and North, C. (2016). Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention. (Abstract only.) Current Psychiatry Reports. 18:5.

The authors summarize recent reviews of child disaster mental health interventions and provide an overview of the "stepped care approach."

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Pfefferbaum, B., Shaw, J., and the American Academy of Child and Adolescent Psychiatry Committee on Quality Issues. (2013). Practice Parameter on Disaster Preparedness. Child and Adolescent Psychiatry. 52(11): 1224-1238.

This "Practice Parameter" includes links to approaches that can be used to assess and manage the behavioral health needs of children and adolescents throughout all disaster phases.

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Rutkow, L., Gable, L., and Links, J.M. (2011). Protecting the Mental Health of First Responders: Legal and Ethical Considerations. (First page only.) Journal of Law, Medicine, and Ethics.

The authors discuss the ethical and legal issues associated with three key areas in first responder mental health: mental health screening; licensure portability of mental health care providers; and workers’ compensation for mental health claims.

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Schonfeld, D.J., Demaria, T., and the Disaster Preparedness Advisory Council and Committee on Psychosocial Aspects of Child and Family Health. (2015). Providing Psychosocial Support to Children and Families in the Aftermath of Disasters and Crises. Pediatrics. 136(4):E1120-E1130.

The American Academy of Pediatrics released this clinical report urging pediatricians to look for common adjustment problems in children following a disaster or crisis, and to promote effective coping strategies to ease the impact of the event. The report stresses the importance of ensuring basic support services, psychological first aid, and professional self-care while working with patients and families in the wake of disaster.

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Schreiber, M. and Gurwitch, R. (2006). Listen, Protect, and Connect: Psychological First Aid for Children and Parents.

This guide can help parents and caregivers provide psychological first aid to their children during and following a disaster.

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Shaw, J., Espinel, A., and Shultz, J. (2007). Children: Stress, Trauma and Disasters. DEEP Center.

The information in this book highlights the effects of stress, disaster, and other traumatic events on children and their families. Information on the physio- and psychological effects stress can have is included, as is information on assessing and treating these negative outcomes.

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* Substance Abuse and Mental Health Services Administration. (2013). Disaster Planning Handbook for Behavioral Health Treatment Programs: Technical Assistance Publication (TAP) Series 34. U.S. Department of Health and Human Services.

The information in this handbook can help behavioral health treatment program staff plan (or enhance existing plans) for all types of disasters. The guide includes informative chapters and templates that can be customized or used as is by program staff.

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Substance Abuse and Mental Health Services Administration. (2022). Mass Violence/Community Violence. U.S. Department of Health and Human Services.

This SAMHSA Disaster Behavioral Health Information Series installment includes links to resources on common reactions to incidents of mass violence, community violence, and terrorism; tips for coping with such incidents; and ways to support children and youth in coping.

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U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2017). Tips for Health Care Practitioners and Responders: Helping Survivors Cope with Grief After a Disaster or Traumatic Event.

This document provides health care practitioners and disaster responders with guidelines for communicating with disaster survivors experiencing grief. It provides background information about the grieving process, and what happens when the grief process is interrupted and complicated, or traumatic grief occurs, as well as helpful resources for additional assistance.

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U.S. Department of Health and Human Services, Administration for Children and Families, Family and Youth Services Bureau. (n.d.). FIRST RESPONDERS: Support for Pregnant Survivors of Abuse or Rape during Disasters. (Accessed 4/1/2020.)

This three-page tip sheet includes information that can help first responders provide support to pregnant women who have been abused or raped following a disaster. It provides links to resources for referrals to additional supportive resources and is also available in Spanish: https://www.phe.gov/Preparedness/planning/abc/Documents/1st-responder-factsheet-spanish.pdf.

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U.S. Department of Health and Human Services, Administration for Strategic Preparedness and Response. (2022). Individual Resilience: Factsheet for Responders.

Responders can learn more about resilience and the advantageous role it plays in disaster response and recovery from this factsheet.

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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Response. (2012). Planning for Psychiatric Patient Movement During Emergencies and Disasters.

This tip sheet highlights basic considerations that can help public health and medical planners prepare for the movement of patients of psychiatric facilities in the event of a disaster.

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* U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2019). Disaster Behavioral Health Preparedness and Response Resources: Resources for Resilient Individuals and Communities.

This webpage lists disaster preparedness and recovery resources for professionals in the disaster behavioral health field.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2018). Working with Trauma Survivors: What Workers Need to Know.

This website provides information on the importance of learning about traumatic stress and how approaching survivors with genuine respect, concern, and knowledge about their process can help move them towards recovery.

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U.S. Public Health Service Commissioned Corps. (n.d.). Mental Health Teams. (Accessed 5/2/2017.)

The U.S. Public Health Service (USPHS) Mental Health Teams (MHT) provide resources and assistance to communities throughout the United States. They were created in 2006 as part of the National Response Plans ESF-8 public health and medical asset provisions and may be deployed in response to an ESF-8 or non-ESF-8 public health emergency. MHT's can also collaborate with local officials and professional groups to assess community mental health prevention and treatment needs, and provide consultation to medical staff.

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Van den Berg, B,, Grievink, L., Yzermans, J. et al. (2005). Medically Unexplained Physical Symptoms in the Aftermath of Disasters. Epidemiologic Reviews. 27(1): 92-106.

The authors discuss the prevalence of certain "Medically Unexplained Physical Symptoms" (MUPS) that arise in some disaster/traumatic event survivors which may help inform healthcare preparedness strategies. They conducted a literature review on 20 years' worth of articles and found the following consistent risk factors for MUPS: gender (females were more likely to suffer from these symptoms); high physical damage linked to the event; and posttraumatic stress symptoms.

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Wender, E. and The Committee on Psychosocial Aspects of Child and Family Health. (2012). Supporting the Family after the Death of a Child. Pediatrics. 130(6): 1164-1169.

This document can help pediatric healthcare providers provide support to families that have lost a child. It highlights the reactions that can be expected, suggests supportive strategies, and includes links to related resources.

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Resources for Survivors

American Psychological Association. (2015). Disasters and Terrorism.

This website (hosted by the American Psychological Association) shares links to resources geared towards disaster survivors. Resources are categorized by topic (e.g., stress, trauma, violence, natural disasters) and include preparedness- and response-oriented information.

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American Psychological Association. (2015). The Road to Resilience.

The website is geared towards disaster survivors and provides information from the American Psychological Association on the definition of resilience, shares strategies for building resilience, and provides ways for locating help.

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* ASPR TRACIE. (2024). Disaster Behavioral Health: Resources at Your Fingertips. U.S. Department of Health and Human Services, Office of the Assistant Secretary of Preparedness and Response.

When disasters strike, the ripple effects can be significant. Incorporating disaster behavioral health (DBH) into all phases of emergency management can ensure resident and responder preparedness, an effective, compassionate response effort, and a more resilient community moving forward. This document provides information on and links to select DBH programs and resources that can be of immediate use to emergency health care providers, emergency management stakeholders, and other professionals and survivors affected by naturally occurring or human-caused incidents.

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* Centers for Disease Control and Prevention. (2018). Coping With a Disaster or Traumatic Event.

This webpage contains links to resources focused on disaster behavioral health. There are resources geared towards individuals, responders, health professionals, and other community members, and some are categorized by hazard. The “Responders: Tips for Taking Care of Yourself” page includes discussion on burnout and self-care techniques.

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Mental Health America. (n.d.). Coping with Disaster. (Accessed 1/11/2021.)

This factsheet highlights common emotional responses to disaster and coping strategies.

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* National Association of County and City Health Officials. (2016). Behavioral Health Videos.

This resource provides a series of seven behavioral health videos, available in English, Spanish, and American Sign Language. Video 2 is focused on stress management tips for first responders.

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National Center for Posttraumatic Stress Disorder. (n.d.). The Impact of Disaster and Mass Violence Events on Mental Health. (Accessed 1/7/2021.)

This online article from the National Center for Posttraumatic Stress Disorder (PTSD) describes common reactions that disaster survivors may experience. While most reactions lessen over time, some may turn into long-term and severe responses, such as PTSD.

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National Child Traumatic Stress Network. (n.d.). Childhood Traumatic Grief Resources for Parents and Caregivers. (Accessed 6/2/2022.)

This webpage contains links to resources that parents and caregivers can use to help children and teenagers through the aftermath of a disaster.

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National Child Traumatic Stress Network. (n.d.). Helping Teens with Traumatic Grief: Tips for Caregivers. (Accessed 4/8/2019.)

This fact sheet includes strategies caregivers can use to help teenagers deal with traumatic grief when struggling with the death of someone close.

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National Institute of Mental Health Information Resource Center. (n.d.). Helping Children and Adolescents Cope with Traumatic Events. (Accessed 5/9/2024.)

This resource identifies common responses to trauma among children adolescents, and what adults can do to help children cope. It is also available in Spanish: https://www.nimh.nih.gov/health/publications/espanol/como-ayudar-los-ninos.

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Substance Abuse and Mental Health Services Administration. (2014). Coping With Grief After Community Violence. U.S. Department of Health and Human Services.

This SAMHSA tip sheet introduces some of the signs of grief and anger after an incident of community violence, provides useful information about to how to cope with grief, and offers tips for helping children deal with grief.

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Substance Abuse and Mental Health Services Administration. (2014). Coping With Stress During Infectious Disease Outbreaks. U.S. Department of Health and Human Services.

This tip sheet lists signs of stress people may experience during an outbreak and suggests strategies for managing the stress. It is also available in Spanish: https://www.store.samhsa.gov/product/Coping-with-Stress-During-Infectious-Disease-Outbreaks-Spanish-/SMA14-4885SPANISH

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Substance Abuse and Mental Health Services Administration. (2014). Taking Care of Your Behavioral Health: Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak. U.S. Department of Health and Human Services.

This tip sheet defines social distancing, quarantine, and isolation; explains how they may be used during an infectious disease outbreak; and provides suggestions for coping when these measures are implemented.

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Substance Abuse and Mental Health Services Administration. (2014). Talking With Children: Tips for Caregivers, Parents, and Teachers During Infectious Disease Outbreaks. U.S. Department of Health and Human Services.

This tip sheet can help adults communicate with children during outbreaks. It is also available in Spanish: https://store.samhsa.gov/product/Talking-With-Children-Tips-for-Caregivers-Parents-and-Teachers-During-Infectious-Disease-Outbreaks-Spanish-/SMA14-4886SPANISH

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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). Tips for Survivors of a Disaster or Other Traumatic Event: Managing Stress. U.S. Department of Health and Human Services.

This fact sheet provides tips for survivors of traumatic events and helps them learn to prevent or manage stress. It is also available in Spanish: https://store.samhsa.gov/product/Tips-for-Survivors-of-a-Disaster-or-Other-Traumatic-Event-Managing-Stress-Spanish-Version-/SMA13-4776SPANISH.

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Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2019). Tips for Talking with and Helping Children and Youth Cope After a Disaster or Traumatic Event: A Guide for Parents, Caregivers, and Teachers. U.S. Department of Health and Human Services.

This fact sheet identifies common reactions of children after experiencing a disaster/ traumatic event and provides information to help parents and teachers respond appropriately and tips on when to seek further support.

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U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2017). Tips for Survivors of a Disaster or Other Traumatic Event: Coping with Retraumatization.

This document explains the signs and symptoms of retraumatization. It provides guidance on how to manage the symptoms, and identifies ways to build resilience, which is the ability to tap into skills and access resources when going through stressful experiences. It provides resources for building resilience and an adequate support system for dealing with triggering events.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2024). Disaster Distress Helpline.

The Disaster Distress Helpline is a free, confidential 24/7 hotline service that provides support for disaster survivors, responders, or anyone experiencing the stress of an event. Users can call or text 1-800-985-5990 and connect with trained and caring professionals from a network of crisis centers across the country. Helpline staff provide supportive counseling, including information on common stress reactions and healthy coping, as well as referrals to local disaster-related resources for follow-up care and support.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Disaster Technical Assistance Center. (2014). How To Cope With Sheltering in Place.

This resource offers tips people can use to cope with sheltering-in-place. It explains reactions people often feel when sheltering-in-place; suggests ways to care for oneself and the family, such as making a plan and staying connected; and provides additional helpful resources.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2010). Self-Care After Disasters.

This website helps explain the steps survivors can take to manage stress after a disaster. It includes a link to handouts for survivors that disaster responders can print and share with community members.

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U.S. Department of Veterans Affairs, National Center for PTSD. (2017). Resources for Survivors and the Public Following Disaster and Mass Violence.

Information on this webpage is geared towards disaster survivors and includes handouts, resources on disaster mental health treatment, how media coverage can affect stress, common reactions to trauma, and how to cope with post-traumatic stress.

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Uniformed Services University of the Health Sciences, Center for the Study of Traumatic Stress. (2019). Center for the Study of Traumatic Stress.

This webpage contains links to resources geared towards survivors and other community members affected by disaster.

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Agencies and Organizations

American Academy of Child & Adolescent Psychiatry. Disaster Resource Center.

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American Psychological Association. Disasters.

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American Telemedicine Association.

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Centers for Disease Control and Prevention. Coping With a Disaster or Traumatic Event.

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RAND Corporation. Community Resilience.

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The Children's Hospital of Philadelphia. Health Care Toolbox.

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The National Child Traumatic Stress Network. Homepage.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Behavioral Health Treatment Services Locator.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Disaster Technical Assistance Center.

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U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Substance Abuse Treatment Facility Locator.

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U.S. Department of Health and Human Services. Office of the Assistant Secretary for Preparedness and Response. Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC).

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U.S. Department of Veterans Affairs. National Center for PTSD.

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Uniformed Services University of the Health Sciences. Center for the Study of Traumatic Stress.

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VA Telehealth Services.

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World Health Organization. Ensuring a Coordinated and Effective Mental Health Response in Emergencies.

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This ASPR TRACIE Topic Collection was refreshed and comprehensively reviewed in May 2019 by the following subject matter experts (listed alphabetically): CAPT S.E. Formanski, Psy. D., ASPR/R3/REC; Brenda Granillo, DBH, MS, MEP, Director, Public Health Preparedness, University of Arizona, Behavioral Health Consultant; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Jennifer Stansberry Miller, MSW, LCSW, Independent Consultant; and Mary Russell EdD MSN, Healthcare Emergency Response Coalition, Palm Beach County Florida.

It was comprehensively reviewed in the Fall of 2015 by: Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Darrin Donato, Senior Policy Analyst, Division for At-Risk Individuals, Behavioral Health, and Community Resilience (ABC), Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services; Stephen Formanski, PsyD, HHS/ASPR/R3/REC; Jack Herrmann, MSEd., NCC, LMHC; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Glenn J. Kashurba, MD, DFAPA, Regional Deputy Chief Medical Officer, National Capitol Region, National Disaster Medical System; April Naturale, PhD, Senior Technical Specialist, ICF International; Kevin M. O'Brien, Ed.D., Director, Disaster Behavioral Health Services, District of Columbia Department of Behavioral Health; and Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital.

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