'They expect us to be there'

Valerie Cole, PhD, arrived in Joplin, Mo., on May 24, less than 48 hours after a tornado plowed through the town, killing more than 130 people, injuring hundreds more and destroying thousands of homes and businesses. When she arrived, rubble stretched as far as she could see.

"You could just feel the despair, and the sadness and fear," says Cole, senior associate for disaster mental health for the Red Cross.

For four days, Cole organized disaster mental health training sessions for local psychologists and licensed mental health professionals, and psychological first aid instruction for Red Cross volunteers. She also visited shattered neighborhoods and talked with survivors at shelters and assistance centers. Just listening to people tell their stories can give them the strength to keep going, Cole says.

"It really helps them cope, in a very fundamental, basic way," she says.

Listening is central to the outreach APA's Disaster Response Network has provided since it was established in 1991.

In the past 20 years, DRN members have responded to the country's greatest disasters, from the 9/11 attacks to 2005's Hurricane Katrina to this spring's onslaught of tornadoes and floods.

"We've definitely become more integrated into the disaster response system, and they expect us to be there," Cole says.

3,000 psychologists strong

The DRN started in 1991 as a statement of understanding between APA and the American Red Cross. The two groups pledged to work together to address the mental health needs of people affected by natural and other disasters.

One of the events that prompted the DRN's creation was the 1989 crash of United Airlines Flight 232 at the Sioux City, Iowa, airport. A total of 111 people died, but 185 passengers and crew survived. When he heard the news of the crash, Gerard Jacobs, PhD, a psychology professor studying stress at the University of South Dakota, and colleague Randy Quevillon, PhD, called the Sioux City chapter of the Red Cross to ask whether they wanted a psychological response team at the crash site. "They said, and I quote, 'As many as you can, and as quickly as you can,'" remembers Jacobs.

Quevillon led the more severely injured to the hospital while Jacobs led more ambulatory survivors. "We were basically the only mental health effort going on at that point," Jacobs says.

Red Cross officials remember the Sioux City crash as a key moment when attention shifted to addressing people's mental health after a disaster, says Rob Yin, who directs the American Red Cross Disaster Mental Health program. "There was significant emotional distress observed in the Red Cross volunteers who were responding, and it was significant enough, and above average enough, to cause people to think maybe we need a specific activity to support volunteers and survivors," Yin says.

Today, the DRN is a nationwide network of 3,000 volunteer psychologists who respond nationally and locally when disaster strikes. These psychologists don't deliver a 50-minute hour of therapy when they encounter survivors. Rather, they impart coping skills, offer emotional support and help survivors restore their individual problem-solving skills.

DRN psychologists played a critical role in responding to the 9/11 terrorist attacks, helping survivors, family members and responders at the World Trade Center and the Pentagon. So far, though, DRN's largest response came in the wake of hurricanes Katrina and Rita in 2005. Almost 900 psychologists traveled to the Gulf Coast for two-week stints to assist survivors and Red Cross workers. A few hundred more psychologists worked with local governments and Red Cross chapters offering shelter and support to hurricane evacuees nationwide.

Evolving to meet the need

As a result of these and other crises, the DRN has evolved to improve its coordination and services. For instance, the DRN has focused more of its efforts on working with state and local governments. DRN volunteers are also helping local Red Cross chapters respond to specific events in their communities, such as fires that displace families, workplace shootings and industrial accidents. Such local work allows DRN psychologists to use their training to help people, but doesn't demand a two-week commitment away from home, says DRN Director Margie Bird. For example, DRN volunteer Kit O'Neill, PhD, of Fargo, N.D., helped organize psychologists throughout North Dakota to be on hand for flooding victims this spring and summer. Working with the state's department of human services, O'Neill organized psychologists to provide telephone support for families in rural counties that lacked access to mental health care.

In another shift from 20 years ago, the DRN focuses on building resilience before a disaster, not just during and after. The latest version of the Red Cross Psychological First Aid course—designed with input from DRN psychologists—teaches resilience and coping skills to everyone for the stresses of everyday life and disaster. Incorporating content from APA's Road to Resilience material, the course's goal is strengthening individual and community resilience before a disaster strikes, and giving people tools to help themselves, and their neighbors, cope better if the worst happens, Yin says.

Today's DRN is also helping to better address relief workers' needs. Last year, the DRN's Advisory Committee helped design a self-screening tool for Red Cross volunteers to identify those having trouble after working at a disaster scene, in order to offer follow-up assistance. DRN psychologists are also working on a predeployment screening for Red Cross volunteers to identify those who might not be in a good position to spend two to three weeks at an out-of-state disaster scene, Yin says.

In another psychologist-driven change, the Red Cross is also using PsySTART, a psychological triage tool that helps volunteers and responders identify survivors who might need more long-term help. Developed by DRN psychologist Merritt "Chip" Schreiber, PhD, who also serves as the Red Cross co-state disaster mental health adviser for southern California, PsySTART also tracks where mental health resources are needed most by mapping the number of people exposed to multiple risk factors.

The DRN is a vital "force multiplier" for the Red Cross's efforts, says Yin. "We have more volunteers, happier volunteers and better-informed volunteers because of the DRN."