The assignment: (4 page paper APA Format)Based on your evaluation of strategies and the situation in the Hurricane Katrina natural disaster, explain which strategies you would use and why. Based on your analysis of the Mississippi crisis plan, explain whi

Field Action Report

Project CREST: A New Model for Mental Health Intervention After a Community Disaster

Through Project CREST, many have receivedpostdisaster support who otherwise would not have sought mental health care.

Carol S. \orth. MD. MPE. and BartyA. Hong. PhD

Wheti the Mississippi Riverand Its tnhutanes no(»ded St. Louis, Mo. m the spring and sum- mer of 1993. 25(1 menial health professionals stood ready to help the thousands whose Ii\es the floods would aJTcct It turned out. however, that most ofthe flixKi vic- tims sought instead the support of community leaders they kneu and trusted.

To meet the need for commu- nity-based disaster suppon. disaster inter\-ention training that had been offered to mental health profession- als dunng the summer of 1993 was adapted to train community re- source personnel, ranging from clergy to police. The result was Project CREST (Community Re- sources for Education. Support, and Training).

CREST"s purpose is to maxi- mize mental health resources within communities by ciiuipping community leaders to pro\ide initial crisis intervention and emotional relief services after community-wide disaster> ,̂ when professional resources arc uften limited. CREST has also been adapted to other types of crisis intervention-

TIiroLigh Project CREST many people have received crisis inter- vention who othenvise would not have sought mental health c:ire.

The CREST training team mcluded psychologists, psychiatry residents, psychi- atric nurses and nurse specialists, clinical social workers, marital and l.imily coun- selors. acti\it\ therapists, and doctoral can- didates in psychology and social work Most were recruited troni Lini\crsit\ incdicjl cen- ter employees or ad\anced docttiral students in social wurk or clinical ps\chology Fund- ing Ircni the James S NKDonnell Inunda- tion supported ihe authors, first, m develop- ing ihe (.'RtSl curneulum and training the trainers and, later, in pnn idmg consultation The curriculum de\elopinent and training oceupied 2 months in late 1443 and early 19 -̂4. the consultation was ongoing through

the summer of 19iJ4 The authors^—a psy- ehiatnst who had clinical expertise with dis- aster populations and a ps\cht>logist cxpen- enced in training health protessionals and communit\ \olunteers—also led the 52- member t RhSl training team.

CRhST partieipants wore recruited through team outreach to communit\ .igen- cies (hat v\ere known for their tlttod relief actiMties The outreach was accomplished via telephone, letters describing the pro- gram, and ••v\ord tif mouth" from pre\ious trainees Participating agencies ineluded po- lice departments and academies, sehool dis- tricts, churches, the Red C ross. women's self-help centers, neighborhood health cen-

Basics of Crisis Intervention

G u i d i n g p r i n c i p l e s ;>.i ; . , . . . . ,

4 Immediate support

4 Stabilize

4 Not therapy

4 Most are not psychiatrically ill—don't "fix"

4 Distress is universal, and we can help with that

4 Refer people you are worried about

Slide used In Project CREST training program. The training covers the basics of responding to community disasters, providing social support to flood victims, and identifying and referring people who may need professional help.

July 2000. Vol. 90. No. 7 Amencan Journal of Public Health 1057

Field .\ctinn Report

Key Findings

• During disasters, victims seek support from trusted members oftheir OWTI com- munities rather than mental health professionals

' Funher training of these community resource persons can expand the availabil- ity of mental health sen ices for individuals after community disasters.

• An educationai curriculum initially designed lor traininc mental health profes- sionals was successful!) adapted tor Project CREST to tram community leaders.

• The same cumcutum proved useful in training elderly volunteers to support their peers in home and heallh care settings

Next Steps

Because o f t h e v u l n e r a b i l t y of St. Louis to Hooding and to earthquakes (the area rests on the country's largest earth- quake fault». CREST will probably see fur- ther action. Other problems that seem at times to loom larger than disaster—issues sueh as school and community violence, the stresses and strains of mental illness, and coping \Mth the AIDS epidemic—will also likely tap into the CREST model. More CREST training will be offered whenever the need occurs. ^

tors, shelters and emergency serviees for youth and adults. Catholic family senices. university student centers, assisted living agencies, state mental health agenetes. AIDS groups, counseling centers, and other community organizations

A half-time projeet director contacted the communitv groups, handled the logis- tics ofthe training, and served as one ofthe trainers. To contain costs. Project C REST paid its trainers an honorarium (SIUU) and reimbursed them for mileage

The mental health professionals trained communitv participants in supportive listen- ing, disaster coping, and triage skills during a 3-hour workshop ihat covered a broad spectrum of issues basic to mental health crisis intervention. Their presentation in- cluded slides, overhead transparencies, tlip charts, and wntten handouts.

The CREST presentation was repeated nearK 300 times for more than 2S(H) trainees at 90 different sites. The prograni v^as so vvell reeeived that a 3-hour sequel to the t~irst presentation vvas held at most sites This sec- ond seminar otlered site-responsive topics of choice, sueh as problem-solving and com- munication skills In addition, a telephone consultatu>n line with project stafTwas made available to trainees and other eoinmunitv individuals; this sometimes led to triage that resulted in utfice appointments lor tliKxl v ic- tims with one of Ihe project leaders (B.H.).

These etforts continued throughout the summer of 1993 as the Mississippi River

mounted 5 distinct flood crests that repeat- edlv threatened communities and generated new and continuing needs for menial health relief The tollowing spring, limited flood- ing recurred in L-onimunities along the Mis- sissippi River near St. Louis. The CREST program was once again called into action. During this short-lived crisis, the CREST professionals were the only mental health workers serving many of these sites.

Other Interventions

Because of CREST's suceess in help- ing \Rtims ofthe W93 and 1944 floods, several groups requested additional training in subject areas other than flooding that were felt to be equal or even more pressing cnses for them, sueh as school v lolence and domestic abuse. The CREST workshop ma- tenals were readilv modified to the alterna- tive subjects, and these presentations were also well reeeived.

The suceess of C REST s model for de- livery of emotional eare led to its use in the Older Adult Serviee and Information Sys- tem (OASISt Institute's "Person to Person" Program in St. Louis. In this pri>gram, which began m 1996. elderly volunteers pro\ ided conversation, communication, and support lor their peers in home and health care settings. The CREST training materi- als and mode! served as the basis for the program.

The authors are vKith the [>epartment of Psychiatry, Washington University School of Medicine, St. Louis. Mo

Requests for repnnts should be sent to Carol S. North. MD. MPE. Departmenl of Psychiatry. Wash- ington l_'ni\ersiiy School ot Medicine. 4940 Chil- dren's Place. St- Louis. MO 63110 (e-mail: northc@ psychiatrv'uusti edu)

This report was accepted February 29. 2000.

Contributors C S North dnd B A Hong jointly designed the proj- eci. implemented the work, and wrote this report.

Acknowledgments This work was supponed by a grant trom the James S. McDonnell Foundation of St. Louis.

Resources 1. Weaver JD Disa.'iters Mental Health Interven-

tions. Sarasota. Fla Professional Resource Press; 1W5

2 Smith HM. North CS. Post-traumatic stress disorder in natural disasters and technological accidents In Wilson .1. Raphael B. eds- Inter- national Handbook oj Traumatic Stress Syn- drtmes- New York. NY: Plenum Press; 1993: 52-95.

3. North CS. Nixon SJ. Shariat S. et al. Psychiatric dlsorde^^ among sur\i\ors ofthe Oklahoma City bombing. J.AMA. 1^^.282755-762.

105H American Journal of Public Health July 2000, Vol. 90, No. 7