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A
Data Sources and Methods
' n order to respond to the study charge, several steps were undertaken
to review the psychological consequences of terrorism, identify gaps
~ in preparedness and response, and provide options to optimize the
public health response. Sources of data and information included the as-
sembly of a committee with appropriate knowledge and expertise; input
from consultants; review of the trauma, disaster, and terrorism literature;
and hosting of a public workshop.
STUDY COMMITTEE
A seven-member study committee was convened to assess available
data and respond to the study charge. The committee was comprised of
members with expertise in disaster psychology, psychiatry, social work,
public health, and emergency medicine. The committee convened for
three two-day meetings on October 7-8, 2002, December 4-5, 2002, and
February 24-25, 2003.
CONSULTANTS
Two consultants with expertise in mental health and public health
provided voluntary service to the committee. They assisted in conceptu-
alizing the framework for the integration of mental health and public
health in responses to psychological consequences of terrorism.
155
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156 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
LITERATURE REVIEW
The study committee was not charged with conducting an extensive
review of the psychological sequelae of terrorism. Rather, the committee's
focus was on providing options for response. Therefore, the literature re-
view was limited to a brief examination of general trauma and disaster
mental health studies and to recent and relevant data on psychological
consequences of and responses to terrorism. The focus was on peer-re-
viewed studies that assessed psychological reactions and symptoms fol-
lowing a variety of traumatic events.
PUBLIC WORKSHOP
As part of the study charge, as outlined in Chapter 1, the study com-
mittee hosted a one-day public workshop at its October meeting in order
to assess the immediate and long-term consequences of terrorism; the
needs of vulnerable populations; the current federal, state, local govern-
ment, and private systems in place to respond to psychological conse-
quences of terrorism; and the capacity of the current infrastructure to meet
mental health needs. The agenda from the workshop is presented on the
following pages.
After opening remarks by Vice Admiral Richard Carmona, M.D., Sur-
geon General; sponsor representatives; Ms. Susanne Stoiber, Institute of
Medicine (IOM), Dr. Richard Nakamura, National Institute of Mental
Health (NIMH); and Ms. Gail Hutchings, Substance Abuse and Mental
Health Services Administration (SAMHSA); the first panel presented vari-
ous aspects of the psychological consequences of terrorism. Dr. Roxane
Cohen Silver addressed the psychological responses to traumatic events
(including mental health and substance use), the impact of trauma for
both short- and long-term functioning, and the similarities and differences
between the consequences of terrorism and other types of trauma. Dr.
Robert DeMartino discussed implications of terrorism in the United States
for the population's mental health (including substance use); the differ-
ences in psychological consequences for mass disaster events, perceived-
threat events, and bioterrorism; and the implications of these differences
for program coordination, evaluation, and outcomes assessment. Dr.
Audrey Burnam provided a review of the mental health consequences of
the attacks on September 11, 2001, including the impact on those affected
directly and indirectly, implications for vulnerable populations (e.g., chil-
dren, emergency responders, ethnic minority or immigrant populations),
and the capacity of the infrastructure to meet mental health needs. After
these presentations, two respondents, Drs. lames laranson and Elizabeth
Todd-Bazemore, engaged in a discussion of considerations for special
OCR for page 157
APPENDIX A
populations
. .
niches.
The second workshop panel reviewed response plans in place at the
federal level, the effectiveness of responses, and ways to address gaps in
current systems of response. The speakers addressed issues regarding the
coordination and integration of services, training of key service provid-
ers, and dissemination of information. Presenters included Mr. Paul
Kesner, U.S. Department of Education; Mr. Seth Hassett, SAMHSA; Colo-
nel Ann Norwood, Uniformed Services University of the Health Sciences;
Dr. Dori Reissman, Centers for Disease Control and Prevention (CDC);
Ms. Kathryn McKay Turman, Federal Bureau of Investigation (FBI); and
Dr. Alfonso Batres, Department of Veterans Affairs (VA).
Speakers on the third panel, Mr. Chip Felton and Dr. Betty
Pfefferbaum, addressed state- and local-level responses, the effectiveness
of responses, and ways to address gaps in current systems of response
including the coordination of services, training of key service providers,
and dissemination of information. Respondents Dr. Ruby Brown, Rever-
end Deacon Michael Murray, and Dr. Judith Shindul-Rothschild discussed
considerations for community- and faith-based approaches and the role
of nursing in mental health responses.
The fourth panel focused on the variety of ways to address gaps in
nongovernmental systems of response and how to best coordinate ser-
vices with federal and state efforts, train key health and human services
providers, and disseminate information. Venues for intervention and ser-
vice agencies discussed included the workplace, primary care, and the
American Red Cross. In addition, lessons from international responses to
terrorism and issues related to risk communications were addressed. Pre-
senters included Ms. Kathleen D'Amato-Smith, Dr. Margaret Pepe, Dr.
Margaret Heldring, Dr. Thomas Bornemann, and Dr. Ivan Walks.
During the final session of the committee's workshop, committee
members reviewed key points from the panels they had moderated. Dr.
Monica Schoch-Spana provided an overview and summary of themes
from the workshop. The session was then opened to the public for further
discussion of gaps in knowledge needed to inform planning and pre-
paredness, intervention approaches to limit adverse mental health conse-
quences, and options to optimize the public health response.
157
including ethnic minority, refugee, and immigrant commu-
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158 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
PSYCHOLOGICAL CONSEQUENCES OF TERRORISM AND
SYSTEMS FOR RESPONSE
Workshop hosted by the Committee on Responding to the
Psychological Consequences of Terrorism
Date: Monday, October 7, 2002
Location: Hubert Humphrey Building, Department of Health and
Human Services
200 Independence Avenue, S.W., Room 800
Washington, D.C.
8:30 a.m. WELCOME AND INTRODUCTIONS
Lewis R. Goldirank, M.D.
Committee Chair
OPENING REMARKS
VADM Richard Carmona, M.D.
Surgeon General
United States Public Health Service
SPONSOR REMARKS
Susanne A. Stoiber
IOM Executive Officer
Richard Nakamura, Ph.D.
Acting Director, National Institute of Mental Health
Gail P. Hutchings, M.P.A.
Acting Director, Center for Mental Health Services
Substance Abuse and Mental Health Services
Administration
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APPENDIX A
9:00 a.m.
159
PANEL ON THE PSYCHOLOGICAL
CONSEQUENCES OF TERRORISM
Moderator
Robert J. Ursano, M.D.
Committee Member
Speakers
Roxane Cohen Silver, Ph.D.
Professor, Department of Psychology and Social Behavior
University of California, Irvine
Robert DeMartino, M.D.
Associate Director, Program in Trauma and Terrorism
Center for Mental Health Services, U.S. Public Health
~ .
service
Audrey Burnam, Ph.D.
Director, Health Division, Center for Research on Alcohol,
Drugs, and Mental Health
The RAND Corporation
Respondents
James Jaranson, M.D., M.A., M.P.H.
Medical Director
Center for Victims of Torture
University of Minnesota
Elizabeth Todd-Bazemore, Ph.D.
Associate Professor
Disaster Mental Health Institute
University of South Dakota
10:00 a.m. QUESTIONS FOR PANELISTS
10:15 am BREAK
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160 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
10:30 a.m. PANEL ON INTERVENTIONS FEDERAL LEVEL
RESPONSES
Moderator
Marleen Wong, L.C.S.W.
Committee Member
Speakers
Paul Kesner
Program Specialist
Safe and Drug Free Schools Program
U.S. Department of Education
Seth Hassett, M.S.W.
Acting Chief, Emergency Services and Disaster Relief
Branch
Center for Mental Health Services
Substance Abuse and Mental Health Services
Administration
Col. Ann Norwood, M.D.
Associate Professor of Psychiatry
Uniformed Services University of the Health Sciences
Dori B. Reissman, M.D., M.P.H.
Senior Medical Officer
Bioterrorism Preparedness and Response Program
National Center for Infectious Diseases
Centers for Disease Control and Prevention
Kathryn McKay Turman
Program Director
Office of Victim Assistance
Federal Bureau of Investigations
Alfonso R. Batres, Ph.D., M.S.S.W.
Chief Officer
Readjustment Counseling Services
Department of Veterans Affairs
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APPENDIX A
11:30 a.m. QUESTIONS FOR PANELISTS
11:45 p.m. BREAK FOR LUNCH
1:00 p.m. PANEL ON INTERVENTIONS STATE- AND
LOCAL-LEVEL RESPONSES
Moderator
Nancy Wallace, C.S.W.
Committee Member
Speakers
Chip Felton, M.S.W.
Associate Commissioner and Director
Center for Performance Evaluation and Outcomes
Management
New York State Office of Mental Health
Betty Pfefferbaum, M.D., J.D.
Chair and Professor
Department of Psychiatry and Behavioral Sciences
University of Oklahoma College of Medicine
Respondents
Ruby E. Brown, Ph.D.
Program Manager, Community Resilience Project
Arlington County Department of Human Services
Reverend Deacon Michael E. Murray, M.A.
Director, Interfaith Crisis Chaplaincy
Taunton, Massachusetts
Judith Shindul-Rothschild, Ph.D., R.N.
Director of Psychiatry and Mental Health
Boston College School of Nursing
2:00 p.m.
161
QUESTIONS FOR PANELISTS
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162 PREPARING FOR THE PSYCHOLOGICAL CONSEQUENCES OF TERRORISM
2:15 p.m.
3:15 p.m.
3:30 p.m.
3:45 p.m.
PANEL ON INTERVENTIONS OTHER RESPONSES
Moderator
Gerard A. Jacobs, Ph.D.
Committee Member
Speakers
Kathleen D'Amato-Smith, C.S.W.
Former Clinical Coordinator, AVP
Merrill Lynch Employee Assistance Program
Margaret M. Pepe, ).D., Ph.D.
Mental Health Officer
American Red Cross Disaster Services
Margaret Heldring, Ph.D.
Executive Director
America's HealthTogether
Thomas H. Bornemann, Ed.D., M.S. W.
Director, Mental Health Program
The Carter Center
Ivan C.A.Walks,M.D.
Former Chief Health Officer and Director
Department of Health, District of Columbia
QUESTIONS FOR PANELISTS
BREAK
DISCUSSION
Moderator
Lewis R. Goldirank, M.D.
Committee Chair
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APPENDIX A
Reviewers
Robert J. Ursano, M.D.
Marleen Wong, L.C.S.W.
Nancy Wallace, C.S.W.
Gerard A. Jacobs, Ph.D.
Monica Schoch-Spana, Ph.D.
Center for Civilian Biodefense
Johns Hopkins University
4:45 p.m. CLOSING REMARKS
Lewis Goldfrank, M.D.
5:00 p.m. ADJOURN
163
Representative terms from entire chapter:
address gaps
