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Research Grants

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Title: Research Grants


1
The Key Roles that Faith Communities play during
Disasters
Harold G. Koenig, MD Departments of Medicine and
Psychiatry Duke University Medical Center GRECC
VA Medical Center
2
Introduction
  • Psychological and spiritual needs during
    disaster
  • Religion, coping with stress, and mental health
  • Role of faith community in preparing for and
  • responding to emergencies, disaster, terrorism
  • 4. Role of the aged and the disabled in preparing
  • for and responding to disaster
  • 5. Importance of coordinating the faith-based
    response, and how to proceed

3
1. Psychological/Spiritual Needs
  • Psychological/spiritual needs influence the role
    that faith communities can play what they are
    depends on time after the disaster event
  • 1. Impact phase (onset of event to end of
    physical damage)
  • Early aftermath phase (from time damage complete
    throughout the time rescuers providing physical
    care to survivors)
  • 3. Short-term aftermath phase (from time rescue
    workers leave to time survivors fully process
    what has happened)
  • 4. Long-term aftermath phase (from time survivors
    have at least temporarily adjusted to years after
    event or rest of life)

4
Impact Phase
  • During time that physical damage actually
  • occurring
  • 2. Hyper-arousal and alertness, followed by
    shock, numbness, and then in some, fear and panic
  • 3. Primary need is information on how to minimize
    injury to person and damage to property
  • Contact with emergency rescue workers is key
  • along with practical assistance to escape

5
Early Aftermath Phase
  • From time that physical damage ends to end of
  • time that rescue workers provide care (up to 1
    wk)
  • 2. Physical needs are a priority psychosocial/
    spiritual needs often put on hold
  • 3. Survivors may experience high anxiety, along
    with physiological responses (shaking, rapid
    pulse, need to use restroom) as shock wears off
    acute stress reactions
  • 4. Need is simple explanations, instructions, and
    reassurance NO NEED FOR ADVICE or counseling
  • 5. Need companionship someone who cares, and is
    willing to stand or sit silently with them,
    meeting basic needs

6
Short-Term Aftermath Phase
  • From time that rescuers leave scene to time that
  • survivors fully process what happened its
    meaning
  • (1-4 weeks to 6-12 months after disaster)
  • Grieving over losses trying to piece back
    together their view of the world, achieve a sense
    of safety, predictability
  • Now is when survivors most need emotional/social
    support and are receptive to it
  • 4. Some may need professional psychological help
    to work through grief others need listening,
    caring ear
  • 5. Many spiritual needs also present (next slide)

7
Spiritual Needs Short-Term Aftermath
  • Worldviews may be shaken. Attempts to
    reconstruct worldview. Is there a caring God who
    is in control?
  • If in control, why did God allow this?
    Punishment?
  • Is God present? Unable to feel distant,
    unconcerned
  • Does God even exist? Dont want to believe in
    God who
  • allowed this.
  • Can I do something so God will allow my loved one
    to recover, me to regain my health, or prevent
    this from happening again? (repentance, penance,
    etc.)
  • 6. Where is my faith community? (if not
    responding)
  • 7. Need to verbalize doubts/anger simple answer
    not helpful

8
Long-Term Aftermath Phase
  • Begins 6-12 months after event (after temporary
    adjustment) after social and professional
    support ended continues for years, or rest of
    survivors life
  • Seeking to achieve long-term adjustment, put life
    together rebuild
  • Memorials and gatherings important, as
    anniversaries bring back pain/grief over the
    event
  • Need periodic emotional/social/spiritual support
    for years
  • Faith community ideally positioned to provide
    this ongoing emotional and practical support
    organize efforts to help survivor help others
    similarly affected, locally or at distance

9
Negative Consequences of Disasters
  • Without adequate social, psychological, and
    spiritual support, negative psychological
    consequences may result
  • 1 in 3 survivors develop PTSD
  • Chronic anxiety and/or depression (widespread)
  • 4. Rescue workers also at risk (1 in 5 with PTSD)
  • 5. At greatest risk
  • - women, the young (or middle-aged with multiple
    roles)
  • - those experiencing concurrent stressors
  • - inadequate social support
  • - low self-esteem
  • - loss of faith

10
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11
Spiritual Injury and PTSD Symptoms
But, loss of faith is no laughing matter, as this
study shows 1,385 veterans from Vietnam (95),
World War II and/or Korea (5) involved in
outpatient or inpatient PTSD programs. VA
National Center for PTSD and Yale University
School of Medicine. Weakened religious faith was
an independent predictor of use of VA mental
health servicesindependent of severity of PTSD
symptoms and level of social functioning.
Investigators concluded that the use of mental
health services was driven more by their weakened
religious faith than by clinical symptoms or
social factors. Fontana, A., R. Rosenheck.
Trauma, change in strength of religious faith,
mental health service use among veterans treated
for PTSD. Journal of Nervous Mental Disease
2004 19257984.
12
2. Religion and Coping with Stress
  • Most information available from persons coping
    with stress of acute and chronic medical illness
  • More limited data on persons coping with
    disasters and acts of terrorism

13
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14
Stress-induced Religious Coping
Americas Coping Response to Sept 11th 1.
Talking with others (98) 2. Turning to religion
(90) 3. Checked safety of family/friends
(75) 4. Participating in group activities
(60) 5. Avoiding reminders (watching TV)
(39) 6. Making donations (36)
Based on a random-digit dialing survey of the
U.S. on Sept 14-16
New England Journal of Medicine 2001
3451507-1512
15
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16
Religious Coping during Disasters (research
studies at individual level)
Natural disasters 1980 Midwest tornado 1989
Hurricane Hugo 1992 Hurricane Iniki 1993 Midwest
flood 1997 Hurricane Nigel 2001 Bhuj
earthquake Acts of War/Terrorism 1991 Gulf
War 1995 Oklahoma bombing 2001 World trade center
attacks 2000-2003 Israeli-Palestinian War see
In the Wake of Disaster (Templeton Press, 2006)
17
Religion and Mental Health Research Before Year
2000
  • Well-being, hope, and optimism (91/114)
  • Purpose and meaning in life (15/16)
  • Social support (19/20)
  • Marital satisfaction and stability (35/38)
  • Depression and its recovery (60/93)
  • Suicide (57/68)
  • Anxiety and fear (35/69)
  • Substance abuse (98/120)
  • Delinquency (28/36)
  • Summary 478/724 quantitative studies
  • Many new studies since 2000
  • (see www.dukespiritualityandhealth.org)
  • Handbook of Religion and Health (Oxford
    University Press, 2001)

18
Cartoon with Prayzac
19
In Conclusion
  • Religious involvement is related to greater
    social support, better mental health, and faster
    adaptation
  • Effects are strongest in those who have the
    greatest stress (consistent research finding)
  • Religion is a powerful coping behavior that works
    best during uncontrollable stress, as that which
    occurs during disasters
  • Besides individual effects of religion on coping,
    what role have the clergy and the faith community
    played in responding to disasters?

20
3. Role of Faith Community in Preparing for and
Responding to Disasters
21
Activities of Clergy/Faith Communities during
Disasters (research studies at community level)
  • Natural disasters
  • 1970 southwestern tornado
  • 1974 Kentucky tornadoes
  • 1985 West Virginia flood
  • 1993 Midwest flood
  • 1997 Tropical cyclone Martin
  • 2005 Hurricane Katrina
  • War and Terrorism
  • 1995 Oklahoma City bombing
  • 2001 World Trade Center attacks
  • see In the Wake of Disaster (Templeton Press,
    2006)

22
Faith Communities with Disaster Response Arms
  • Every major religious denomination in the U.S.
    has one among the largest are
  • Adventist Community Service
  • American Baptist Men Disaster Relief
  • Ananda Marga Universal Relief Team (Hindu)
  • Catholic Charities Office of Disaster Response
  • Christian Disaster Response
  • Christian Reformed World Relief Committee
  • Church of the Brethren Disaster Response
  • Mormon Humanitarian Service
  • Episcopal Relief and Development
  • Friends Disaster Service
  • International Aid (evangelical Christian)
  • Lutheran Disaster Response
  • Mennonite Disaster Service
  • Nazarene Disaster Response
  • Presbyterian Disaster Assistance
  • Reformed Church World Service
  • Salvation Army

23
How do Individual Faith Communities Prepare for a
Disaster?
  • Two-thirds of Americans are members of faith
    communities
  • Faith communities, because of their religious
    beliefs, are naturally drawn to responding to
    those in need, both within and outside of their
    congregation
  • Although most religious denominations already
    have disaster preparation and response arms, on
    the individual congregation level, little is
    being done in terms of preparation
  • Unless preparation done, responses after disaster
    often weak and ineffective what should local
    religious congregations do to prepare?

24
Preparing for Disaster What should faith
communities do?
  • Have a town meeting with representatives of faith
    communities in the area
  • Obtain info on and discuss the disaster risks in
    the area
  • Develop a formal, written disaster plan (for each
    congregation and across congregations) make
    flexible
  • Have a plan in place for taking care of the needs
    of the elderly and disabled, who may need special
    assistance
  • Partner with formal emergency management services
    (EMS) and with voluntary disaster response groups
    attend at their planning meetings develop
    relationships
  • Identify the special assets that the faith
    community (FC) possesses (and identify those that
    EMS and other disaster response groups possess)
  • Develop an understanding with EMS groups on what
    the FCs specific role will be during disasters,
    based on the unique assets that it has (in
    coordination with others)

25
Preparing for Disaster What should faith
communities do?
  • Miscellaneous
  • 8. Every 6-12 months, run through
    disaster-response plan as if a disaster has
    occurred so that kinks in plan are worked through
  • 9. Have a stock-pile of canned goods, power
    supplies available in the church building, and
    have a contingency plan in place if the church
    building is destroyed by the disaster
  • 10. Arrange a pact with another
    church/synagogue/mosque
  • located in a different city to partner with in
    case one or the other is disabled
  • 11. Identify a single person within each
    congregation to be point person to contact (and
    have a backup person also) these persons should
    have specialized disaster training a course on
    critical incident stress management and
    possibly seek certification
  • 12. Identify persons within the faith community
    to serve as spiritual guides and counselors
    during a disaster, and train them to do so
    beforehand

26
What Should Faith Communities do when a Disaster
Occurs (Response)
  • When disaster occurs, point person in
    congregation is notified
  • Point person initiates and executes the
    congregations disaster response plan
  • Point person, who has a communications device
    unlikely to be disabled during a disasters,
    contacts others (church EMS)
  • Elderly, disabled, other vulnerable persons
    attended to first next, members within
    congregation then, outside congregation
  • Basic needs are met (rescue) and supplies are
    distributed (water, food, clothing, shelter)
  • All of the above in coordination with local EMS
    services and ARC
  • Assistance sought from denominational response
    arms, non-affected churches in community, partner
    church in other locale
  • Finances raised, resources gathered, volunteers
    recruited
  • After impact phase, volunteers provide
    companionship after early aftermath phase,
    provide support and more active psychological,
    social and spiritual support then, long-term
    support

27
4. Role of the Aged and Disabled in Preparing
for, Responding to Disasters
  • During disasters, the aged and disabled can be a
    huge burden
  • Preparation beforehand, however, can make them a
    huge asset

28
Role of the Aged and Disabled in Preparing for
Disasters
  • 1. The aged and disabled have one thing that most
    others dont ---- time
  • 2. The aged and disabled may also have other
    assets desire to make a difference, motivation
    for life to have meaning, and experience dealing
    with stress, trauma and tragedy
  • Disaster preparation and training takes time and
    motivation to make a difference.when nothing is
    happening so, most healthy, independent, active
    people dont take time to do so
  • This leave a big opening for the aged and
    disabled
  • Of course, there are limitations need to be
    attended to

29
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30
Role of the Aged and Disabled in Preparing for
Disasters (cont)
  • 1. The aged and disabled should be encouraged to
    obtain formal disaster training (read, watch
    video, take course over internet, take course in
    person)
  • 2. At a minimum, they will learn how to prepare
    to be as little a burden as possible during a
    disaster (which itself will contribute
    meaningfully to disaster response)
  • 3. At a maximum, they can help to coordinate the
    disaster response and serve as the point person
  • 4. Most aged and disabled persons can do
    something in between 2 and 3 but they must be
    motivated and the SYSTEM must make room for them

31
5. Coordinating the Faith Response
  • Results of lack of coordination
  • - duplication of services to some people
  • - other people completely lacking services
  • - competition/conflict with EMS (i.e.,
    well-meaning church people get in the way)
  • - competition/conflict with other volunteers
    (religious non-religious)
  • - anger, frustration, EMS complaining,
    volunteers quitting
  • - harm done as people without training disturb
    disaster survivors by unneeded or misdirected
    helping, evangelizing, etc.
  • Most of these can be avoided by preparation and
    coordination

32
How to Coordinate?
  • First, faith organizations and EMS groups need to
    learn what the other has to offer and appreciate
    and value it
  • Then, they will WELCOME each other into their
    respective disaster preparation planning meetings
    and be included in overall formal disaster plans
    (which needs to occur)
  • Thus, education on both sides is needed,
    especially awareness by traditional, formal EMS
    groups of what faith communities have to offer
  • Faith communities, though, must assign and train
    leaders to participate in these planning meetings
    and give input
  • What specific EMS groups need to include faith
    community representatives in their planning
    meetings?

33
What EMS Groups Need Faith Community
Representatives at their Meetings
  • Local immediate responders (police,
    fire-fighters, emergency medical technicians)
  • City or county emergency management groups (run
    out of the mayors office)
  • 3. State emergency management agencies (SEMA)
  • 4. State mental health agencies (SMHA)
  • 5. Federal emergency management agencies (FEMA)
  • 6. American Red Cross (which has its own
    disaster spiritual care services, but this is
    highly limited, and may not want to share
    responsibilities)

34
Dont Reinvent the Wheel
There already exists faith community coordinating
groups at the national level However, their
activity and effectiveness may not always be
optimal, and they may or may not have an impact
at the local level
35
National Bodies Coordinating Faith-Based Disaster
Preparation and Response
  • Church World Service Emergency Response Program
    (CWS)
  • - 35 Protestant, Anglican, Orthodox bodies
  • National Voluntary Organizations Active in
    Disasters (NVOAD)
  • - 23 of its 35 member-organizations are
    religious bodies (including Catholic Charities,
    Lutheran Disaster Response, and Salvation Army)
  • Action by Churches Together (ACT) International
  • - works through 195 Protestant and Orthodox
    Churches around the world
  • Association of Evangelical Relief Development
    Organizations (AERDO)
  • - 45 evangelical Christian relief and
    development agencies

36
Need for Coordination at the Local Level
  • Again, dont reinvent the wheel. Local
    congregations in disaster-prone areas of the
    country have already gone through this
  • Find out what they are doing, what they have
    tried, what has not worked and why.. and learn
    from their experiences
  • Based on what they learn, faith communities
    should then strategize on how to best approach
    EMS agencies in their area and become more
    involved in formal disaster preparation and
    response plans
  • All this must be done BEFORE a disaster strikes

37
Summary
  • Psychological and spiritual needs of disaster
    survivors and families depend on time after the
    event impact, early aftermath, short-term
    aftermath, and long-term aftermath phases
  • Religious beliefs and practices are powerful and
    effective coping behaviors, especially during
    uncontrolled, severe stress
  • Clergy and religious communities play key and
    critical roles in responding to disasters, and
    over the long haul, may be essential for
    community resilience
  • The aged and disabled may be a huge asset during
    disaster, if they are adequately prepared
    beforehand
  • Coordinating the disaster response is crucial,
    and faith community representatives should sit at
    the table with EMS planners and their roles
    written into disaster plans

38
More Information
  • In the Wake of Disaster Religious Responses to
    Terrorism Catastrophe (Templeton Press, 2006)
  • http//www.templetonpress.org/book.asp?book_id84
  • 2. Southern Medical Journal, September 2007
    issue, special section on Spirituality and
    Catastrophe
  • http//www.sma.org/smj/
  • 3. Developing a disaster plan for a congregation
  • http//www.ldr.org/prepare/
  • 4. More information on Spirituality and Health
  • http//www.dukespiritualityandhealth.org
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