The COVID-19 Pandemic and the Five Essential Elements in Mass Trauma Intervention: Perspectives from World Trade Center Health Program Mental Health Clinicians

Details

• Personal Author:
  Haugen, Peter T. ; Lowe, Sandra M. ; Marrone, Kathryn ; Reissman, Dori B. ; Rosen, Rebecca
• Description:
  In 2007, Hobfoll and coauthors described "Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence," a framework to guide intervention and prevention efforts in the aftermath of mass trauma. Briefly, these include promoting safety, calm, self- and community efficacy, connectedness, and hope for the future. These evidence-informed elements have been used in early disaster interventions, such as Psychological First Aid (Brymer et al., 2006), and have widely influenced international public health policy. This commentary will address whether these elements have provided guidance when applied to the setting of the COVID-19 pandemic. As of this writing (July 11, 2021), there have been more than 185 million confirmed cases of COVID-19 world-wide, resulting in over 4 million reported deaths (Johns Hopkins Coronavirus Resource Center). This international public health disaster, tremendous in scope and scale, has unfolded in unyielding and uneven waves, affecting different regions of the world with varied intensity over the past 18 months. Global mortality, societal and economic disruption, and the protracted nature of the crisis have overwhelmed medical facilities, health care systems, and communities. Inconsistent messaging about the transmissibility of the virus and seriousness of COVID-19 magnified uncertainty and fear. Early efforts focused on containing the spread of infection and managing serious respiratory illness. This quickly grew to include concern about the psychological trauma surrounding both the seriousness of the disease and the psychosocial and economic effect of its containment efforts. A large body of evidence reveals that during the initial phase of the pandemic, there was an increase in levels of anxiety, depression, substance misuse, and suicidal ideation in the U.S. (e.g., Czeisler et al., 2020; Ettman et al., 2020). Notably, youth, women, and those caring for young children - groups not previously identified as high risk for psychiatric disorders - experienced disproportionate psychological distress and possible increases in self-harm (Aknin et al., 2021). The perspective of this commentary is that of mental health clinicians at the World Trade Center Health Program (the "Program"), which monitors and treats persons affected by a prior mass disaster, the 9/11 terror attacks. Once again, we were called upon to provide care while facing an unfolding public health disaster in parallel with our patients and our colleagues when rates of COVID-19 were soaring in the greater New York City area early in 2020. Thus, the focus is on pragmatic aspects of clinical management and "hands-on" delivery of care. Key features of the Program's response to the pandemic are discussed, using a time-phased framework for interventions as described by (Rauch et al., 2020). Attention is drawn to elements as they manifested over time, or phases, of the pandemic. The authors reflect on how their approach and practices aligned with the five elements identified by Hobfoll et al. Program responses that reflected connectedness are highlighted as they proved to be most salient in our clinical experience during the COVID-19 pandemic. It is hoped that this perspective will enrich the understanding of how the five essential elements interface with clinical interventions and disaster-related public health practices. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Mental Health Nervous System Occupational Health Public Health Safety September 11 Terrorist Attacks Virus Diseases
• Keywords:
  COVID-19 Disaster Response Mental Health Psychological Processes Public Health World Trade Center WTC
• ISSN:
  0033-2747
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  District of Columbia ; New York ; OSHA Region 2 ; OSHA Region 3
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  WTCHP - World Trade Center Health Program
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  8 pdf pages
• Volume:
  84
• Issue:
  4
• NIOSHTIC Number:
  nn:20066949
• Citation:
  Psychiatry 2021 Winter; 84(4):386-392
• Contact Point Address:
  Sandra M. Lowe, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
• Email:
  Sandra.lowe@mssm.edu
• Federal Fiscal Year:
  2022
• Peer Reviewed:
  False
• Source Full Name:
  Psychiatry
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:232c7d2a9282413768e14e469665ba1157ad58867108146a29bfcd74ec9d1ae048062ca59bc71c514243232d8e456fb0f09a9be94d31f9ce43241bc89e67f4ba
• Download URL:
  https://stacks.cdc.gov/view/cdc/230690/cdc_230690_DS1.pdf
• File Type:
  [PDF - 457.28 KB ]