Disasters

BACKGROUND

Definitions

Several definitions are frequently applied to disaster. A disaster can be an event that causes extensive destruction, death, or injury and that produces widespread community disruption and individual trauma (Hartsough & Myers, 1987). Disasters may be occurrences of nature such as a hurricane, tornado, storm, flood, high water, tidal wave, earthquake, volcanic eruption, drought, blizzard, pestilence, or fire (American Red Cross, 1991); they may have a technological cause such as hazardous waste contamination or nuclear accident; or they may be the result of human error or equipment failure such as transportation accidents, industrial accidents, dam breaks, or building or structural collapse. In addition, acts of terrorism, riots, kidnapping, and random acts of violence may be viewed as disasters. The disaster may be either sudden or slow and insidious over several months; it may be unexpected or have some degree of predictability .

For policies related to the social work profession, it is important to conceptualize disasters in a framework that encompasses the breadth of responses compatible with social work knowledge and skills at the macro, mezzo, and micro levels. Disasters are but one subcomponent of extreme stress situations. This overall category of phenomena_extreme stress situations_ may be subdivided into two major areas: (1) situations that affect individuals (such as rape or other violent crime, a serious home fire, or a tragic accident) and (2) extreme, collective situations. A collective stress situation is one in which a social system fails to provide expected life conditions for its members. Collective stress situations are divided into disasters and conflicts; conflicts include such events as wars, riots, and terrorist attacks (Quarantelli, 1985). Using this framework, disaster trauma exists at two levels: individual and collective. Disaster creates trauma for entire communities by virtue of massive disorganization, immobilization of infrastructure, and hiatus of customary leadership, all of which produce trauma, grief, and a sense of helplessness in individuals, families, and small groups owing to losses, severe disruption, and frustrated attempts to obtain assistance and solve problems.

Across the duration of a disaster, four stages have been identified that provide chronological targets for social work responses: (1) preimpact, beginning when a disaster poses no immediate threat but prompts mitigation and preparedness activities; (2) impact, or the period when the disaster event takes place; (3) postimpact, or the period immediately after the impact up to the beginning of recovery; and (4) recovery, or the period in which disaster survivors are working toward restoration of their predisaster state (American Red Cross, 1993). It is useful to services delivery to recognize the short- and long-term stages of recovery; the latter sometimes require years. For example, nearly three years after the assault of Hurricane Andrew on South Florida in August 1992, the Miami Herald reported that more than 1,000 families continued to live in severely damaged structures (Arthur, 1995).

Populations at Risk and Outcomes

Within a community affected by disaster, several categories of victims can be defined: Primary or impact victims are those who have experienced direct physical, material, and personal losses from the disaster; context victims are those who have witnessed the destruction of the disaster (such as the death or material losses of family or friends and the sociocultural disorganization of the postimpact environment) but have not directly experienced the specific impact; entry victims are people who enter the impact area during the postdisaster crisis period (such as police and military personnel, rescue workers, government officials, and volunteers) and who are exposed to the death and destruction; and peripheral victims are those who were not directly affected by the disaster but who suffer distress and uncertainty over the safety and well-being of family and friends (Bolin, 1986; Dudasik, 1980). Among these categories of disaster survivors and victims are the vulnerable populations of central concern to the social work profession: poor people; older people; people with disabilities; people who are isolated, institutionalized, or otherwise at risk; and all exposed children. These populations may be among the most vulnerable disaster survivors and may require special attention during preparedness, immediate relief, and recovery.

The course of recovery is patterned and predictable, with steps that include (1) heroism, (2) honeymoon, (3) response, (4) recovery, and (5) reconstruction (American Red Cross, 1992). Effective interventions are tailored to the phase of recovery. During these recovery phases, it is common for a second disaster to occur: The emergency bureaucracy's uncoordinated, ineffective, and at times misguided response and unwieldy procedures often inadvertently create or magnify difficulties and impose barriers to problem solving.

The outcomes of disaster events have immediate and long-term biological, psychological, social, and environmental consequences, that social workers from all fieLDF of practice will need to consider in their response activities. Outcomes for victims and survivors, particularly those who are most vulnerable, also include extensive damage to property and possessions, dislocation, unemployment, health and coping problems, and death. There are a range of reactions to the stress that are universal, normal for the situation, and widely shared and that abate naturally (Cohen & Ahearn, 1980). Typical reactions include feelings of distress, grief, diminished role functioning, problems in living, irritability, frustration, guilt, and disillusionment. But most disaster survivors' individual behavior is organized, controlled, and adaptive. Survivors often exhibit selflessness and personal strength. A strengths model (as opposed to pathology and deficit models) should guide disaster-related interventions.

A significant percentage of survivors develop profound, debilitating posttraumatic stress reactions requiring extended mental health interventions rather than short-term disaster assistance. These extreme stress reactions include fear and irrational behavior, shock, immobilization, withdrawal, denial and intrusive thoughts, hypervigilance, easy startle, insomnia, decreased attention and concentration, and psychophysiological reactions (Cohen & Ahearn, 1980; Forster, 1992). Children are especially vulnerable and often display stress reactions such as fear, sleep disturbances, separation anxiety, confusion, disruptive classroom behavior, and aggressiveness (Farberow & Gordon, 1986; Forster, 1992). Older people, who tend to be more resilient than younger disaster survivors (Bell, 1978; Huerta & Horton, 1978), also include a frail and vulnerable subgroup who may be displaced from extended-care facilities in the disaster impact area. Other high-risk survivors include people with physical disabilities; people with histories of stressful life events and dysfunctional coping patterns (Forster, 1992); and people with intense exposure to the disaster's impact, including emergency workers, first responders, and rescue teams. Rescue workers, working under a high degree of concentration and physical demand, witness firsthand the breadth of destruction, identify and remove the deceased, and are exposed to situations that compromise their physical safety. Disaster personnel, especially those who themselves are primary victims, therefore experience the additive effects of the disaster event, the aftermath, and unique occupational stressors (Hartsough & Myers, 1987).

Some survivors experience the reactivation of distress at anniversary points. Furthermore, the phases of a disaster widely accepted by the emergency response institutions_mitigation and preparation, response, and recovery_fail to emphasize the long-term recovery stage, during which a segment of survivors continue to struggle to reestablish their homes or other predisaster circumstances at two, three, and four years after the disaster. For some, especially those who were highly exposed and bereaved, the experience of distress persists past the disaster event for some time, even as long as 14 years (Green et al., 1990). In many cases, the people or families plunged into precarious economic situations as a result of the disaster or whose situations were marginal before the disaster become substantially worse off because of the disaster.

Research

Research on the human services aspects of disaster has focused on mental health outcomes. In a review of research on the effects of disaster on mental health, Green (1993) found 131 quantitative empirical studies of people exposed to natural or technical disasters. Many of these studies were descriptive. The number of studies using control group designs was fewer than 25. Natural prospective (single-group pretest-posttest) and retrospective designs with large numbers of subjects were few. Intervention research (assessing program or treatment outcomes) was virtually nonexistent, as was research informing disaster response services systems and structures (Dodds & Nuehring, in press). The scarcity of disaster-related research is a result, in part, of limited access to subjects (survivors) who receive postdisaster services.

Social work research on disasters is only now beginning to emerge (Ager & Zakour, 1995; Cherry & Cherry, 1995; Dodds & Nuehring, in press; Gillespie, Sherraden, Streeter, & Zakour, 1986; Rogge, 1995). Furthermore, little has been done to disseminate information systematically about disasters and disaster response to social workers through the established journals and communication channels of the profession.

Management of Disasters

The social disorganization surrounding a disaster and the number and types of responding organizations and groups create the need for a well-ordered mass response system. For routine, daily emergencies, local public and private entities have responsibilities typically determined by charters and laws. A disaster, in contrast, may be viewed as an occurrence of such magnitude that it cannot be managed by a single entity or routine procedures. Consequently, a complex organizational environment has developed to respond in disaster situations.

Federal laws (in particular, the Disaster Relief Act of 1970, the Disaster Relief Act Amendments of 1980, and the Robert T. Stafford Disaster Relief and Emergency Assistance Act) grant authority to the federal government to provide assistance in defined disasters. The Federal Emergency Management Agency (FEMA) administers the federal natural disaster relief programs and civil defense systems. FEMA supplements state and local governments in emergency response operations and may order any other federal agency (for example, the Departments of Agriculture, Defense, Health and Human Services, or Justice) to directly help state and local governments. These agencies, in turn, mobilize such functions and services as emergency transportation, communications, emergency food distribution and mass care, housing, direct financial assistance, emergency medical care, crisis counseling programs, search-and-rescue operations, mortuary services, and construction management (Myers, 1994).

To mobilize these organizations, a declaration of disaster is initiated according to an increasing level of emergency. A local emergency is declared when the governance of a city or county deems conditions to pose an extreme threat to the safety of people and property within that jurisdiction. When the disaster conditions threaten the safety of people and property within a state, the governor may proclaim a state of emergency, making mutual aid assistance mandatory from other cities, counties, and state authorities. When damage exceeds the resources of local and state governments, the president may declare a disaster, which may activate two types of federal assistance as provided for in the Stafford Act. Individual assistance may include low-interest loans, individual and family grants, temporary housing, and crisis counseling. Public assistance in a disaster declared by the president may include search-and-rescue operations, repair and replacement of public property such as roads, and debris clearance. The president also may declare a state of emergency, which authorizes emergency mass care, search-and-rescue operations, and emergency transportation (Myers, 1994).

In addition to FEMA and state and local governments, several volunteer agencies assume defined roles and responsibilities in disaster situations. Chief among these is the American Red Cross. In 1905 a congressional charter (reaffirmed by the Disaster Relief Act of 1970 and the Stafford Act, as amended in 1988) designated the American National Red Cross to conduct a system of national and international relief to mitigate the suffering caused by pestilence, famine, fire, floods, and other great national calamities and to develop and execute measures for preventing these events (American Red Cross, 1991). Using voluntary contributions, the Red Cross coordinates with local, state, and federal resources to disseminate official warnings, conduct voluntary evacuation, provide emergency shelter and services, and coordinate a trained volunteer rescue corps.

A host of other key volunteer organizations are involved in disaster response, including the Salvation Army (bulk food distribution, mass shelter facilities, trained staff and volunteers, crisis intervention, financial assistance), Volunteers of America (ambulances and air transportation and rescue), the United Methodist Church, the Southern Baptist Convention, the National Catholic Conference and Catholic Charities, the Mennonite Disaster Services, and the Christian Reformed World Belief (Myers, 1994).

Following two major airline crashes in the mid-1980s, the Dallas branch of the Texas chapter of NASW, in cooperation with the Dallas area chapter of the American Red Cross, submitted a request for mental health disaster services that was later implemented by the National Red Cross. As a result of this policy decision, several professional organizations have entered into a statement of understanding with the American Red Cross. NASW entered into such an agreement in 1990 (NASW & American Red Cross, 1990). The California chapter of NASW, Los Angeles County regions, developed a statement of understanding with the American Red Cross in 1993. These agreements were developed to facilitate social worker participation in the planning, training, and provision of mental health services to disaster victims and Red Cross personnel as needed (NASW & American Red Cross, 1993). Various NASW chapters have developed agreements with other volunteer organizations, such as the North Carolina chapter's agreement with the Salvation Army.

ISSUE STATEMENT

Disasters are collective, communitywide traumatic events that cause extensive destruction, death, or injury and widespread social and personal disruption. They apparently are becoming more frequent as populations concentrate in coastal areas at high risk for natural disasters such as hurricanes (Freedy, Resnick, & Kilpatrick, 1992) and in urban centers at high risk for technological and industrial disasters (Baum, 1987; Freedy et al., 1992). Additionally, a changing global political climate has led to an increase in terrorism and random acts of violence. Striking whole locales, disasters may endanger and overwhelm already vulnerable members of the community, such as children and people who are older, disabled, isolated, institutionalized, in out-of-home care, or living in compromised housing.

In addition to empirical studies that have accumulated on the effects of disasters, much practice wisdom has evolved around the delivery of disaster assistance. Even though an immense emergency response system of voluntary and government organizations has become established, disasters continue to be undermitigated, not prepared for, and significantly mismanaged. This "second disaster" is cited as creating more long-lasting and severe stressors for survivors and victims than the original disaster (Cohen & Ahearn, 1980; Myers, 1994). Much remains to be understood, and many systems and policies require significant refinement, if not reconcept-ualization, if disaster response is to advance in quality and effectiveness.

NASW has adopted a disaster policy at the national level for four primary reasons:

1. Disasters are large-scale catastrophes that affect whole communities or multiple communities in geophysical, social, and psychological ways.

2. The trauma and deprivation resulting from disasters often are magnified for those with few resources and reduced opportunities to rebuild homes and replace losses. As such, vulnerable populations, such as children, older people, or people with disabilities, are likely to be among those especially affected by disasters.

3. Of all the allied health and human services professions, social work is uniquely suited to interpret the disaster context, to advocate for effective services, and to provide leadership in essential collaborations among institutions and organizations. Individuals, families, groups, neighborhoods, organizations, schools, interorganizational networks, and whole communities require intervention. Furthermore, compatible with social work epistemology, disaster assistance must be construed holistically, encompassing the physical, developmental, psychological, emotional, social, cultural, and spiritual needs of survivors. Finally, respected disaster response modalities readily translate to the language of empowerment and classic, generalist social work practice.

4. Although social workers have been quick to respond to need in the immediate aftermath of disasters, they have largely provided direct casework and, at times, community organization services to survivors and have received little recognition for their efforts. Social work's input in planning for disaster response at national, state, and local levels has usually been negligible; social work research on disaster is only now emerging (Ager & Zakour, 1995; Cherry & Cherry, 1995; Dodds & Nuehring, in press; Gillespie et al., 1986; Rogge, 1995). Practically no intervention research has been done to date on the outcomes of disaster assistance efforts. The importance of the potential contribution and role of social work warrants more than ad hoc, intuitive, spontaneous responses on a disaster-by-disaster basis. Effective disaster leadership and a proactive presence on the part of the profession require preparation, direction, training, and rehearsal.

POLICY STATEMENT

NASW supports participation in and advocates for programs and policies that serve individuals and communities in the wake of disaster. NASW supports

• the prevention or mitigation of the adverse consequences of disaster and effective preparation for disaster by individuals, families, social networks, neighborhoods, schools, organizations, and communities, especially where vulnerable populations are concentrated
• enhancement of the efficiency, effectiveness, orchestration, and responsiveness of disaster relief and recovery efforts to prevent the second disaster phenomenon that magnifies the trauma of the initial catastrophe
• the provision of mental health and social services to survivors in a context of normalization and empowerment, with sensitivity to the phases of disaster recovery and with understanding of the unique cultural features of the affected community and its populations
• attention to the protracted recovery phase of disasters that leaves substantial numbers of people without resources, without resolution of their losses, and with little opportunity to restore their predisaster quality of life
• attention to the special and critical training, stress management, and support needs of disaster workers in all capacities, from administrative to field staff, and the need to respond to their circumstances as victims and survivors
• education of social workers and social work students in the specialized knowledge and methods of trauma response and critical incident stress debriefing
• the development of rigorous disaster research, especially intervention effectiveness research
• the development of a cadre of well-trained disaster professionals committed to effective interdisciplinary and interorganizational collaboration in disaster planning and disaster response, at both the administrative and direct services levels
• the presence, commitment, and leadership of social workers in disaster services
• the provision of accurate and effective public information on the normal stages of disaster reaction, functional coping methods, and strategies for accessing and successfully using the disaster assistance bureaucracy.

REFERENCES

Ager, R. D., & Zakour, M. J. (1995, March). Network exchange and the coordination of disaster relief services. Paper presented at the Annual Program Meeting of the Council on Social Work Education, San Diego.

American Red Cross. (1991). Statement of understanding between the American Psychological Association and the American Red Cross (ARC Publication No. 4468). Washington, DC: Author.

American Red Cross. (1992). Disaster mental health services I: Glossary of terms (ARC Publication No. 3077-1A). Washington, DC: Author.

American Red Cross. (1993). Disaster services regulations and procedures (ARC Publication No. 3077-1A). Washington, DC: Author.

Arthur, L. (1995, April 6). Two S. Dade cities angered over vote on hurricane relief fund. Miami Herald, p. 28.

Baum, A. (1987). Toxins, technology, and natural disasters. In G. R. VandenBos & B. K. Bryant (Eds.), Cataclysms, crises, and catastrophes: Psychology in action (pp. 9-53). Washington, DC: American Psychological Association.

Bell, B. D. (1978). Disaster impact and responses: Overcoming the thousand natural shocks. Gerontologist, 18, 531-540.

Bolin, R. (1986). Disaster characteristics and psychosocial impacts. In B. J. Sowder (Ed.), Disasters and mental health (pp. 11-36). Washington, DC: American Psychiatric Press.

Cherry, A. L., & Cherry, M. E. (1995, March). Research as social action in the aftermath of Hurricane Andrew. Paper presented at the Annual Program Meeting of the Council on Social Work Education, San Diego.

Cohen, R. E., & Ahearn, F. L. (1980). Handbook for mental health care of disaster victims. Baltimore: Johns Hopkins University Press.

Disaster Relief Act of 1970, P.L. 93-288, 88 Stat. 164.

Disaster Relief Act Amendments of 1980, P.L. 96-563, 94 Stat. 3334.

Disaster Relief and Emergency Assistance Amendments of 1988, P.L. 100-707, 102 Stat. 4689 to 4711.

Dodds, S. E., & Nuehring, E. M. (in press). Preparation for disaster: A formula for social work research. Journal of Social Service Research.

Dudasik, S. (1980). Victimization in natural disaster. Disasters, 4, 329-338.

Farberow, N. L., & Gordon, N. S. (1986). Manual for child health workers in major disasters (DHHS Publication No. ADM 86-1070). Washington, DC: U.S. Government Printing Office.

Forster, P. (1992). Nature and treatment of acute stress reactions. In J. H. Gold (Series Ed.) & L. S. Austin (Vol. Ed.), Clinical practice: Volume 24. Responding to disaster (pp. 25-52). Washington, DC: American Psychiatric Press.

Freedy, J. R., Resnick, H. S., & Kilpatrick, D. G. (1992). Conceptual framework for evaluating disaster impact: Implications for clinical intervention. In J. H. Gold (Series Ed.) & L. S. Austin (Vol. Ed.), Clinical practice: Volume 24. Responding to disaster (pp. 3-23). Washington, DC: American Psychiatric Press.

Gillespie, D. F., Sherraden, M. W., Streeter, C. L., & Zakour, M. J. (1986). Mapping networks of organized volunteers for natural hazard preparedness (Publication No. PB87-182051/A09). Springfield, VA: National Technical Information Service.

Green, B. L. (1993). Mental health and disaster: Research review (Report to NIMH, Requisition 91MF175040). Washington, DC: Georgetown University Medical Center, Department of Psychiatry.

Green, B., Grace, M., Lindy, J., Gleser, G., Leonard, A., & Kramer, T. (1990). Buffalo Creek survivors in the second decade: Comparison with unexposed and nonlitigant groups. Journal of Applied Social Psychology, 20, 1033-1050.

Hartsough, D. M., & Myers, D. G. (1987). Disaster work and mental health: Prevention and control of stress among workers (DHHS Publication No. ADM 87-1422). Washington, DC: U.S. Government Printing Office.

Huerta, F., & Horton, R. (1978). Coping behavior of elderly flood victims. Gerontologist, 18, 541-546.

Myers, D. (1994). Disaster response and recovery: A handbook for mental health professionals (DHHS Publication No. SMA 94-3010). Washington, DC: U.S. Government Printing Office.

National Association of Social Workers/American Red Cross. (1990). Statement of understanding between National Association of Social Workers and the American Red Cross. Washington, DC: Authors.

National Association of Social Workers/American Red Cross. (1993). Statement of understanding between the California chapter of the National Association of Social Workers, Los Angeles County regions and the American Red Cross. Los Angeles: Authors.

Quarantelli, E. L. (1985). An assessment of conflicting views on mental health: The consequences of traumatic events. In C. R. Figley (Ed.), Trauma and its wake: The study and treatment of post-traumatic stress disorder (pp. 173-215). New York: Brunner/Mazel.

Robert T. Stafford Disaster Relief and Emergency Assistance Act, P.L. 93-288, 88 Stat. 143.

Rogge, M. E. (1995, March). Reducing community vulnerability to technological and natural hazards: Tool for empowerment. Paper presented at the Annual Program Meeting of the Council on Social Work Education, San Diego.

Suggested Readings

Austin, L. (Ed.). (1992). Clinical practice: Responding to disaster. Washington, DC: American Psychiatric Press.

Green, B., Grace, M., Lindy, J., Titchener, J., & Lindy, J. (1983). Levels of functional impairment following a civilian disaster: The Beverly Hills Supper Club fire. Journal of Consulting and Clinical Psychology, 51, 573-580.

Holen, A. (1991). A longitudinal study of the occurrence and persistence of post-traumatic health problems in disaster survivors. Stress Medicine, 7, 11-17.

Lima, B., Pai, S., Lozano, J., & Santacruz, H. (1990). The stability of emotional symptoms among disaster victims in a developing country. Journal of Traumatic Stress, 3, 497-505.

Phifer, J., & Norris, F. (1989). Psychological symptoms in older adults following natural disaster: Nature, timing, duration, and course. Journal of Gerontology: Social Sciences, 44, S207-S217.

Shore, J., Tatum, E., & Vollmer, W. (1986). Psychiatric reactions to disaster: The Mount St. Helens experience. American Journal of Psychiatry, 143, 590-595.

Weisaeth, L. (1989). A study of behavioral responses to an industrial disaster. Acta Psychiatrica Scandinavica, 355 (80 Suppl.), 131-137.

Policy statement excerpted from Social Work Speaks, 5th Edition: NASW Policy Statements, 2000-2003, from NASW Press (2000).