Program Overview:

This innovative workshop will examine the relevance of using helping models from developing countries with long-standing conflict in the work with communities in New York City affected by the 9/11 terrorist attacks. In particular, comprehensive community-based psychosocial and mental health interventions developed in Uganda, Sudan and Burundi, to assist populations affected by violence will be examined. These build on the natural strengths of the traditional African society, empowering families and communities to manage members' psychosocial concerns.

Topics to be discussed include:

- Effect of mass community education about psychosocial and mental health issues on community values and attitudes

- Implementation of community crisis intervention teams and their effectiveness in reducing deaths by suicide and controlling family and community violence

- Effect of recreation and cultural activities on enhancing the self-esteem of youth and promoting peace and reconciliation between warring tribes.

- Use of story-telling to promote family communication about traumatic events and facilitate healing.

- Effects of spirituality and traditional belief on emotional well-being.

- "Cascade" of training approach which promotes community self-help.

Discussion will focus on reasons for these interventions' effectiveness in the African context, and on how the underlying principles and techniques can provide useful direction for community interventions with violence-affected and refugee populations in the U.S. Nancy Baron received her Doctorate in Education at the University of Massachusetts in Family Therapy and Counseling Psychology. For the past 12 years, she has lived and worked in war-torn countries, including Sri Lanka, Cambodia and Indonesia. She is, at present, the Psychosocial Advisor for the Transcultural Psycho-Social Organization (TPO), a Dutch non-governmental organization specializing in community based psycho-social and mental health work with victims of war. Currently based in Africa, Dr. Baron coordinates programs for refugees and internally displaced people in Uganda, Southern Sudan and Burundi.

This workshop is partially funded by a grant from the Office of Refugee Resettlement, US Department of Health and Human Services.

The Ground Zero Community Initiative is a grass roots, ITSP-sponsored, community-strengthening project supporting families and educators in the downtown school communities most affected by the 9/11 events.

The International Trauma Studies Program is sponsored by the Department of Psychiatry New York University School of Medicine. It operates as an interdepartmental collaboration between the Ehrenkranz School of Social Work, the Division of Nursing and the Department of Applied Psychology at NYU's School of Education, and the Center for War Peace and the News Media at NYU's Department of Journalism and Mass Communication.

This workshop will focus on traumatic stress and the family system, four months after the tragedy. The following topics will be covered:

IMPACT

A. Sense of safety
B. Home
C. Caretaking capabilities
D. Sense of meaning and predictability of life
E. Day to day routines

SEVERAL PROCESSES COINCIDING AMONG THOSE AFFECTED

A. Greiving of varying sorts
B. Acute traumatic response
C. Post traumatic symptoms
D. Dislocation of daily routines
E. Reorganization of daily life
F. Survivorship
G. Development of personal and family narratives
H. Developement and new stresses over the past 4 months

KEY ASPECTS OF SUCCESSFUL COPING

A. Knowledge
B. Predictable sense of the future
C. Active role in resolution of immediate problems
D. Competency in day to day activities
E. Meaningful and useful social support
F. A sense of meaning and value associated with survival and recovery
G. Degree of recognition and regard socially for pre or during tragedy behavoir

DIFFERENCES AMONG THOSE WHO SEEK ASSISTANCE

A. Loss of a close family member-spouse
B. Loss of a close friend or colleague
C. Loss of one or more individual one feels responsible for
Loss of an acquaintance
E. Survivor of hte tragedy
F. Observer whos life (home, work, school) was disrupted by the tragedy
G. Observer who did not experience direct loss and who experienced minimal life disruption
Distant observer (through media) whose effect has been mainly cognitive and emotional and whose difficulties most closely reflect pre-existing problems

SIGNS OF DISTRESS

A. Depression
B. Trauma Reactions
C. Other Symptoms

INTERVENTIONS

A. Availability and listening
B. Education about symptoms
C. Repetitive reassurance about normailty of emotional response
D. Encourgement of recognizing options and making decisions
E. Support for recognizing "true self" and basic responsibilites
F. Support for competency
G. Accepting recurrent experience of distress and long term nature of recovery
H. Constantly reminding individual of their value, of their struggle to establish meaning and of their need to establish a new equilibrium

ASSISTANCE FOR CHILDREN

A. What children need
B. Response depends to a large degree upon response of parents/caretakers
C. Maintenance of daily routine very helpful
D. Explanations and discussion must fit developmental level and must be repeated
E. Children with preexisting difficulties will have most difficulty with loss
F. Support for competence and achievement essential
G. Spiritual values often very helpful
H. Parents/caretakers will need support and space for dealing with their own emotional reactions, greiving losses and redirecting their lives as adults
I. Simultaneously each family remembers its loss and pursues its new reality
J. Decrease parent-child role reveral

COMMUNITY REACTIONS

A. Many communities affected by the tragedy
B. Time frames for grieving, remembering and recovery may not be synchronous
C. Communities include institutions affected and which can provide support simultaneously for grieving and continued funtioning
D. Challenge to communities involves how to be different and renewed differently

ROLE OF RECOVERY EFFORTS

A. Financial support
B. Involvement in memorialization
C. Bureacratic processes-death certificates, etc.
D. Role of heroism and recognition of herosim
E. Survivors' experience , loss and efforts to establish meaning
F. National efforts, role of war effort and efforts toward establishing accountability
G. Lingering desire to return to 8:40am Tuesday, September 11, 2001

THE INDIVIDUAL AND FAMILY NARRATIVE: IN THE END IT IS EACH INDIVIDUAL'S AND FAMILY'S STRUGGLE TO DEVELOP HIS/HER/THEIR OWN COHERENT STORY (STORIES) OF THEIR LOSS(ES) THAT IS MOST IMPORTANT AND THE EFFORT OF HELPERS IS TO FURTHER THAT PROCESS AND WITNESS/SUPPORT THAT STRUGGLE. EACH INDIVIDUAL'S/FAMILY'S STORY WILL BE UNIQUE AND LIVING OUT THAT STORY WILL PRESENT UNIQUE CHALLENGES.

COMPASSION FATIGUE: REMEMBER THE POSSIBILITY OF COMPASSION FATIGUE AMONG THE HELPERS (YOU) ESPECIALLY WHEN THEY (LIKE ALL OF US) HAVE BEEN TRAUMATIZED BY THE SAME TERRORISTIC EVENTS.

A. A. Appreciate the need for respite and the need for support for one’s own reaction to the tragedy.
B. Recognize when supervision is helpful
C. Appreciate the need to pursue one’s own relationships and interests or hobbies
D. It is essential to share the stories of the work and create one’s own narrative of the experience
E. Appreciate that each individual will need to pursue his or her own path to adaptation
F. Maintain focus upon your specific agenda

Enhancing Resilience in Families and Communities
Speaker: Professor Judith Landau, M.B., Ch.B., D.P.M., National Jewish Medical and Research Center, Boulder, CO

Friday, December 21, 2001
9:00 AM - 1:30 PM
New York University, Main Building, ROOM 809
100 Washington Square East
(between Waverly and Washington Place) 

Family and community support have been found to be the most crucial factors in successful recovery following disasters similar to those of September 11. This workshop offers a framework for designing multi-systemic interventions for prevention and resolution of trauma. Particular attention will be paid to:

1. Traumatic Stress and the Family System
   
   1. Eliciting and understanding family themes, scripts, strengths and resources.
      
   2. Learning to mobilize family resources towards resilience rather than vulnerability.
      
   3. Basic techniques for intervening in families.
      
   4. An introduction to Transitional Family Therapy.
2. Building Healthy and Resilient Communities
   
   1. Enhancing collaboration between natural and artificial support systems.
      
   2. Understanding the cultural contexts and dimensions of trauma and the impact of trauma on communities and society at large.
      
3. Mobilizing the Community Towards Primary Secondary and Tertiary Prevention
   
   1. Designing multi-systemic interventions for prevention and resolution of trauma.
      
   2. Considering all levels of individual, family and community involvement, with special attention to issues of health, spirituality, culture and life cycle stage of individuals, families and community. Assessing available resources and vulnerabilities, protective factors, and interventions for each level.

Mental health professionals offering on-going services for those affected by the recent terrorist attacks on September 11th will find a phase-oriented approach to the treatment of trauma and loss very helpful in organizing treatment interventions. This workshop will offer a review of the following:

1. Phases of Trauma Recovery and Intervention
   
   1. Stabilization and safety
      
   2. Working through trauma (Remembrance and Mourning)
      
   3. Reconnection
      
2. Ingredients for Successful Intervention
   
   1. Cultural factors
      
   2. Symptom management
      
   3. Complicated or pathological bereavement
      
   4. Reestablishment of functioning: work, family, and identity

Caregivers and Clinicians who are working with those affected by the World Trade Center Disaster.

HOW THE MIND PROCESSES TRAUMATIC EXPERIENCES: THINKING, FEELING AND SENSING.

ATTACHMENT AND THE ROLE OF COMMUNITY IN THE HEALING PROCESS

PSYCHOLOGY OF TRAUMA:

How the brain processes extreme events.
Psychophysiology and neuroendocrinology of trauma: therapeutic implications.
Trauma and memory: the fragmentation of traumatic memories and somatic re-experiencing.
The Body keeps the score.

DEVELOPMENTAL CONSIDERATIONS. CHILDREN AND ADOLESCENTS.

CULTURAL CONSIDERATIONS: HOE CULTURAL CONSTRUCTS AFFECT THE TRAUMA RESPONSE

ASSESSMENT

Coping styles and mechanisms.
How preexisting character affect response and treatment.
Resources.

TREATMENT

Techniques of debriefing
Pros and cons of debriefing.
The phase oriented treatment approach
Stabilization and resource building.
Psycho-education, somatic approaches and psychopharmacology
Creating a narrative.
Finding "stuck points" and triggers.
Processing fragmented memories: EMDR, and other non-verbally oriented techniques.
Group psychotherapy approaches

TRAUMA THEORY AND ITS RELATIONSHIP TO THE TERRORIST ATTACKS OF 9/11

A Brief History of the Trauma Field
Terminology and Definition
Philosophy of Intervention - Normal Response Vs. Pathology?
A Family and Community Centered Approach
How can we use what we already know about trauma? How is this event different?
Traumatic Grief
Ongoing Anxiety and Threat

PSYCHOBIOLOGY OF TRAUMA

How the brain responds to threat
The impact of trauma on memory

SYMPTOMS: Physiologic, Affective, Cognitive and Behavioral

What is "normal"? What is commonly experienced?
Peri-traumatic responses
Long-term effects
Specific populations
Responses of Children and Adults

DSM IV TR

Controversies and concerns

ASSESSMENT AND INTERVENTIONS

Recognizing risks and vulnerabilities
Age and developmental status
Previous traumatic events
Intervention Approaches: Immediate and Long Term

Finding Safety and Stability
Psycho-education
Cognitive and Physical Management of Reactions and Responses
Social Support (being supported and supporting others)

Minimizing re-traumatization through self-care

Media influences
Closure vs. Re-activation of the traumatic response.

INTERVENTION DESIGNS

A Family centered approach
Group work (community and workplace)
School and Community Based Designs
Supervision
Referral sources

VICARIOUS TRAMATIZATION AND THE CLINICIAN

Risk factors
Prevention Strategies