Abstract

In the past, psychological intervention subsequent to mass disasters/acts of terrorism has been characterized by reactive, event-specific practices that all too often overlook the variability inherent in the temporal trajectory of the human response to such events. In essence, these so-called univariate crisis intervention models can trace their origins back to community mental health initiatives (Decker & Stubblebine, 1972; Langsley, Machotka, & Flomenhaft, 1971; Parad & Parad, 1968), the outpatient community psychiatry movements (Caplan, 1961, 1964), as well as the ‘‘forward psychiatry’’ initiatives of the great World Wars (Artiss, 1963; Kardiner, 1941; Salmon, 1919). Given the original intent and design of these models, it is not surprising that they are not easily transferable to the disaster mental health field. Although mass disasters and terrorism affect whole communities of individuals, all individuals in the community do not react the same to such events. Stated another way, some (but not all) individuals exposed to a disaster will need assistance and not everyone will benefit from the same type of assistance (National Institute of Mental Health [NIMH], 2002). In fact, only the minority of individuals exposed to traumatic events will require formalized intervention beyond perhaps information and reassurance (NIMH, 2002; United States Department of Health and Human Services, 1999). The challenge, therefore, becomes identifying those who require more structured intervention from those who do not. This observation has recently pushed ‘‘interventionists,’’ sometimes reluctantly, to now consider adding the skills of assessment and strategic planning to their therapies. The emerging model must therefore be one of a continuum of care in order to accommodate the varied aspects and challenges of disaster response. One potential framework that may assist disaster mental health interventionists to plan and structure such a revised therapeutic program is a framework that engages the concepts of resistance, resilience, and recovery. The impetus and foundation of this framework are based on a presentation to the Johns Hopkins Conference on Mental Health by Kaminsky (2003). In that conference, Dr. Kaminsky discussed the need for a paradigmatic shift away from previous disaster mental health practices that were (a) void of adequate assessment; (b) reactionary From the Johns Hopkins University School of Medicine. Contact author: Alan M. Langlieb, Assistant Professor. E-mail: alanglie@jhmi.edu.

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