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  • Mental Health Interventions by Telephone with Katrina Survivors
  • Don C. Combs EdD (bio)
Keywords

Telephonic responses, mental health interventions, disaster, crisis

Much has been written about the delivery of face-to-face mental health crisis intervention services to both disaster survivors and first responders to those disasters.1–15 In fact, an intense national debate as to the most effective ways to intervene immediately following a traumatic or disaster-related event remains unresolved.1 In question is the efficacy of a long-standing psychological debriefing procedure, Critical Incident Stress Debriefing. This approach, developed by Mitchell and Everly,2–4,5 has yielded somewhat disappointing results according to McNally, Bryant, and Ehlers, who indicate that, "Although the majority of debriefed survivors describe the experience as helpful, there is no convincing evidence that debriefing reduces the incidence of post-traumatic stress disorder (PTSD) and some controlled studies suggest that its use may impede natural recovery from trauma" (p. 45).1 As an alternative, crisis intervention specialists currently recommend a relatively new approach, Psychological First Aid.1,6–8 The principles of this approach, which focuses on meeting each individual's crisis-related psycho-bio-social needs in a practical manner, through developing an action plan for recovery, among other things, are outlined in significant detail at the National Center for PTSD and the National Child Traumatic Stress Network website.9 The effectiveness of this approach requires continued empirical analysis.1,6

Although telephone hot-lines have been considered integral to crisis-oriented mental health services6,10,11 since the mid-1950s,11 only one research study6 has investigated their use as part of early intervention disaster-oriented mental health services.6 Interestingly, the national debate noted earlier has focused primarily on face-to-face contact rather than contact via telephone. Notably, the delivery of mental health interventions by telephone was widely used by the American Red Cross in the aftermath of Hurricane Katrina.

Description of Telephone Services Model

Several years ago, the American Red Cross established a National Call Center in Falls Church, Virginia whose on-going purpose is to act as a 24-hour a day, 7 days a week [End Page 271] information clearinghouse for callers needing emergency assistance and services as a result of disaster-related losses. The role of the call agent answering incoming calls is to connect the caller with local resources and services near the caller's home area. A unique characteristic of the call center approach is the provision of psychological assistance on an as-needed basis to those callers experiencing mental, emotional, and/or behavioral distress. When a call agent identifies a caller in need of such assistance, a licensed mental health professional is asked to plug in to the agent's phone system to assist with the call. The assistance rendered by the mental health professional is based on the caller's needs and thus, follows an individualized plan as suggested by the Psychological First Aid model.1,6–8

The National Call Center became a major hub for Gulf Coast callers after Katrina. What was unique about Katrina calls was that all callers were using cell phones, since landlines were not functional. Call responders worked eight-hour shifts (7 am–3 pm; 3 pm–11 pm; or 11 pm–7 am) each day. A high volume of incoming calls daily (approximately 100 to 150) was the norm, occasionally resulting in a distressed caller having to talk to a call agent until a mental health worker was available. More mental health volunteers were needed than were available, especially on the night shift, which only had two or three workers (compared with the three to five workers on the day and evening shifts).

My Experience

As a licensed professional mental health counselor and certified American Red Cross Disaster Mental Health worker, I volunteered to assist with the Katrina relief effort and was deployed to the National Call Center in mid-September 2005 for a 12-day period. I attended a mandatory general orientation session the day after my arrival and began working the phones the following day. I worked the 11 pm–7 am shift each night. I was not given specific...

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