Mitigating Vulnerabilities and Enhancing Strengths in the Wake of Typhoon Haiyan/Yolanda

By Mary E. Sormanti and Marianne R. Yoshioka

Just as those of us in and around New York City were starting to reconcile with the transition into fall and the impending arrival of another Northeast winter, Typhoon Haiyan/Yolanda struck the Philippines with anything but natural subtlety. One of the most powerful storms ever recorded, Typhoon Yolanda’s initial brutal impact and still unfolding aftermath are wrenching reminders that human vulnerability and need are omnipresent. Thousands of people were killed, thousands more suffered serious, life-threatening or life-altering physical injury, and an estimated 9.5 million people are in immediate need of shelter, food, clean water, clothing, or other life essentials given the widespread destruction of homes and local infrastructure. (For updated and detailed impact data, go to the Center for International Disaster Super Typhoon Haiyan/Yolanda Information page.)

The devastation underlying these numbers, and represented perhaps more fully in the photographs and personal stories coming from the Philippines, is difficult and painful to fathom. In addition to the storm’s initial, “primary” victims, countless others may also experience distress even though their exposure to the disaster is less direct. These include:

1. family members and close friends of those killed, injured, or otherwise directly-affected;
2. first-responders and others who enter the disaster impact area and have observed the destruction first-hand; and
3. those who witness the destruction via media coverage.

Within each of these groups of survivors and victims are individuals who may be especially vulnerable to both disaster exposure and negative outcomes. These populations—which include older adults, children, people with physical, emotional, and intellectual disabilities, people living in poverty, and people who are institutionalized (e.g. in hospitals, jails, nursing homes) or otherwise marginalized within our society—warrant specific attention during all disaster-related intervention and prevention.

Social workers are uniquely poised to observe, engage, and support individuals, families, and communities as they manage these consequences and strive toward improved outcomes. All disaster, whether natural or human-made, is inherently unsettling. Despite increased attention to disaster response and preparedness efforts at local, national, and international levels, harmful psychological and relational consequences are commonplace. So too is evidence of breathtaking human strength, capacity, and responsibility, always tipping the imbalance back in the direction of survival and growth.*

There are numerous examples of social workers helping people inside disaster-affected communities to mitigate their vulnerabilities and enhance their stengths. At CSSW, our full and part-time faculty and advisors have given great time, thought, and expertise to a range of projects, presentations, classes, trainings, and publications in response to the Hurricanes Katrina and Rita; the 9/11 attacks; the crash of American Airlines Flight 587; the earthquake in Haiti, the tsunami in Japan, and the Newtown shootings.

What have we learned from studying social service needs in the wake of large-scale disaster? Among the most important lessons are:

• Disasters vary in their scope (e.g. local, national, international; number of people, structures, and services affected), intensity (e.g. degree of force, extent of damages), and duration.
• The effects of disaster on any given individual are likely to be multi-faceted; manifest reactions (whether short- or long-term) may be physical, cognitive, emotional, behavioral, and spiritual in nature. Psychosocial intervention with those affected by disaster (broadly referred to as “disaster mental health”) requires careful, integrated assessment and attention to each of these areas; and delivery of disaster mental health services is not limited to social workers.
• Disaster mental health differs from traditional mental health and psychotherapy models aimed at treating pathology via group and individual interventions.  Disaster mental health services focus on normalization of acute stress reactions and active prevention of stress-related pathology.
• The health and mental health effects of disaster (e.g., anxiety, depression, post-traumatic stress) are correlated with many micro- and macro-level factors including an individual’s level of exposure to the current disaster, an individual’s trauma and mental health history, availability and access to post-disaster resources, level of social cohesion in the affected community, and scope of the disaster event.
• Because there is significant diversity of vulnerabilities, stresses, and resources within and across sub-groups of a population, every individual and community may be at risk for the deleterious effects of disaster. Nevertheless, considerable research has documented increased risk for a variety of post-disaster problems in the following sub-groups, which may warrant specific attention:
  • pregnant women, mothers, widows
  • young men at risk of detention
  • children who live or work on the streets, undernourished children
  • elderly people
  • people who live in extreme poverty
  • refugees, internally displaced persons, migrants
  • people in institutions
  • people experiencing severe social stigma
  • people with severe physical or psychological disorders and disabilities
  • people exposed to or at heightened risk for human rights violations
• Meaningful social work assessment explores individual and community assets and resources as well as needs and problems; it is an ongoing, dynamic, and collaborative process between the social worker and the affected individual/community.
• Psychological First Aid (PFA), an evidence-informed approach for assisting people in the immediate aftermath of disaster, is generally recognized as an essential foundation for all disaster mental health response efforts. The components, guiding principles, and techniques of PFA have been identified by consensus among a group of health and mental health experts; they have been deemed effective at helping survivors across lifespan development stage, cultural context, and field setting, to manage post-disaster distress and adversity. NOTE: The Psychological First Aid/PFA Practicum Operations Guide, 2^nd edition, is posted on the U.S. Department of Veterans Affairs website and is available as a PDF download (186 pages).
• Often at a time of disaster individuals question life, the world, and their role within it. Many individuals look to their faith for answers and solace. Other begin to question the meaning of their faith.  It is important for social workers to allow these conversations to emerge. When desired, social workers can help to create opportunities for individuals to connect with their faith or religious institutions.

The role for social work services is not only the immediate aftermath but extends over a much longer time horizon. Those affected will need support over the long term. Social workers can play an important role in helping individuals, families, and communities at anniversary points. There can be much need for community work post-disaster, helping communities to come together for healing and growth. There are ways by which a disaster or responses to it bring to the fore issues of social inequity. Social workers can give a voice to those who are unheard and engage in advocacy to bring about greater inclusion and social justice.

Mary Sormanti is a Professor of Professional Practice, and Marianne R. Yoshioka is the Associate Dean for Academic Affairs and an Associate Professor of Professional Practice, at the Columbia School of Social Work. Dr. Sormanti served as the Clinical Program Director for a newly developed Project Liberty funded program that addressed the mental health needs of individuals and families affected by the terrorist attacks of September 11, 2001.

* Examples of local and international Typhoon Yolanda relief efforts abound (e.g., the November 14^th launch of an emergency radio station in Tacloban city—one of the most badly-affected areas—broadcasting information about access to local sources of aid; Google’s release of a Typhoon Yolanda  “person finder” (connecting those directly affected by the storm to loved ones around the world; a November 26th fundraiser, “Waterproof,” at Lerner Hall, organized by Columbia University’s Liga Filipina; and a November 26^th benefit concert at the NYU Global Center for Academic and Spiritual Life with proceeds going to the National Alliance for Filipino Concerns USA’s Bayanihan Relief and Rehabilitation Program. For additional details and examples, see the websites for: the United States Agency for International Development, the United Nations Office for the Coordination of Humanitarian Affairs, and The National Alliance for Filipino Concerns.

Annotated Resources:

Disaster Help: A portal website offering disaster management information and resources culled from multiple federal agencies.

National Institute of Mental Health (NIMH): Part of the U.S. Department of Health and Human Services, this agency conducts and disseminates research on many aspects of mental health, including disaster impact.

Bliss, D., & Meehan, J. (2008). Blueprint for Creating a Social Work-Centered Disaster Relief Initiative. Journal of Social Service Research, 34(3), 73-85.

Breckenridge, J., & James, K. (2012). Therapeutic responses to communities affected by disasters: The contribution of family therapy. Australian and New Zealand Journal of Family Therapy, 33(03), 242-256. Go to abstract.

Brymer, M, Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson, P. (2006). (National Child Traumatic Stress Network and National Center for PTSD). Psychological First Aid: practicum Operations Guide, 2nd ed.

Call, J. A., Pfefferbaum, B., Jenuwine, M. J., & Flynn, B. W. (2012). Practical Legal and Ethical Considerations for the Provision of Acute Disaster Mental Health Services. Psychiatry: Interpersonal & Biological Processes, 75(4), 305-322.

Christ, G. (2010) Social work contribution to a comprehensive model of mourning: the experience of bereaved families of fire-fighters killed on 9/11/01. In M. Davis & S. Payne (Series Eds.), Progress in Palliative Care.

Commers, M. J., Morival, M., & Devries, M. W. (2012). Toward best-practice post-disaster mental health promotion for children: Sri Lanka. Health Promotion International. Available in PDF (6 pages).

Forneris, C. A., Gartlehner, G., Brownley, K. A., Gaynes, B. N., Sonis, J., Coker-Schwimmer, E., … & Lohr, K. N. (2013). Interventions to Prevent Post-Traumatic Stress Disorder: A Systematic Review. American Journal of Preventive Medicine, 44(6), 635-650. Available in PDF (16 pages).

Halpern, J. & Tramontin, M. (2007). Disaster Mental Health: Theory and Practice. Belmont, CA: Thomson Brooks/Cole.

Hamiel, D., Wolmer, L., Spirman, S., & Laor, N. (2013). Comprehensive child-oriented preventive resilience program in Israel based on lessons learned from communities exposed to war, terrorism and disaster. In Child & Youth Care Forum (pp. 1-14). Springer US.

Kalayjian, A. & Eugene, D. (Eds.) (2009). Mass Trauma and Emotional Healing around the World: Rituals and Practices for Resilience and Meaning-Making. Santa Barbara, CA: Praeger.

Kristensen, P. (2012). Disaster-related bereavement: A study of long-term mental health effects and interventions. Available in PDF (164 pp.).

La Greca, A. M., & Silverman, W. K. (2009). Treatment and prevention of posttraumatic stress reactions in children and adolescents exposed to disasters and terrorism: What is the evidence?. Child Development Perspectives, 3(1), 4-10. Available in PDF (7 pages).

Masten, A. S., & Narayan, A. J. (2012). Child development in the context of disaster, war, and terrorism: Pathways of risk and resilience. Annual Review of Psychology, 63, 227-257. Available in PDF (34 pages).

McFarlane, A. C., & Williams, R. (2012). Mental health services required after disasters: learning from the lasting effects of disasters. Depression research and treatment. Available in HTML & PDF.

McIntyre, J., & Goff, B. S. N. (2012). Federal Disaster Mental Health Response and Compliance with Best Practices. Community Mental Health Journal, 48(6), 723-728. Go to abstract.

Plough, A., Fielding, J. E., Chandra, A., Williams, M., Eisenman, D., Wells, K. B., Law, G.Y., Fogleman, G., & Magaña, A. (2013). Building community disaster resilience: perspectives from a large urban county department of public health. American Journal of Public Health, 103(7), 1190-1197. Available in PDF (9 pages).

Raviola, G., Eustache, E., Oswald, C., & Belkin, G. S. (2012). Mental health response in Haiti in the aftermath of the 2010 earthquake: a case study for building long-term solutions. Harvard Review of Psychiatry, 20(1), 68-77. Go to abstract.

Ritchie, C.E., Watson, P.J. & Friedman, M.J. (Eds.) (2006). Interventions Following Mass Violence and Disasters: Strategies for Mental Health Practice. New York: Guilford Press.

Salloum, A., & Overstreet, S. (2012). Grief and trauma intervention for children after disaster: exploring coping skills versus trauma narration. Behaviour research and therapy, 50(3), 169-179.Go to abstract.

Schreiber, M., Pfefferbaum, B., & Sayegh, L. (2012). Toward the Way Forward: The National Children’s Disaster Mental Health Concept of Operations. Disaster Medicine and Public Health Preparedness, 6(02), 174-181. Go to abstract.

Taylor, L. K., Weist, M. D., & DeLoach, K. (2012). Exploring the use of the interactive systems framework to guide school mental health services in post-disaster contexts: building community capacity for trauma-focused interventions. American Journal of Community Psychology, 50(3-4), 530-540. Go to abstract.

Tol, W. A., & van Ommeren, M. (2012). Evidence-based mental health and psychosocial support in humanitarian settings: gaps and opportunities. Evidence Based Mental Health, 15(2), 25-26. Available in PDF (3 pages).

Walsh, F. (2007). Traumatic loss and major disasters: Strengthening family and community resilience. Family Process, 46(2), 207-227. Available in PDF (22 pages).

Webb, Nancy Boyd (Ed.) (2004). Mass Trauma and Violence: Helping Families and Children Cope. New York: Guilford Press.

Wise, J.B. (2005). Empowerment Practice with Families in Distress. New York: Columbia University Press.

Related Links:

• The Social Work Response to Typhoon Haiyan
• Statement by Dean Jeanette C. Takamura in Wake of Boston Marathon Tragedy
• Gun Law Reform and Mental Health in Wake of Newtown—A CUSSW Panel
• Mass Murder: Is There A Mental Health Issue?
• NEWTOWN TRAGEDY: Recommendations for Coping with the Psychological Aftermath
• Experiences of—and Responses to—Hurricane Sandy within the CUSSW Community

Image: “Villagers of Tanza queue for essentials distributed by Save the Children,” taken 21 November 2013 by DFID – UK Department for International Development, courtesy Flickr Creative Commons.