Research Grants

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The Key Roles that Faith Communities play during
Disasters
Harold G. Koenig, MD Departments of Medicine and
Psychiatry Duke University Medical Center GRECC
VA Medical Center
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Introduction

• Psychological and spiritual needs during
  disaster
• Religion, coping with stress, and mental health
• Role of faith community in preparing for and
• responding to emergencies, disaster, terrorism
• 4. Role of the aged and the disabled in preparing
• for and responding to disaster
• 5. Importance of coordinating the faith-based
  response, and how to proceed

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1. Psychological/Spiritual Needs

• Psychological/spiritual needs influence the role
  that faith communities can play what they are
  depends on time after the disaster event
• 1. Impact phase (onset of event to end of
  physical damage)
• Early aftermath phase (from time damage complete
  throughout the time rescuers providing physical
  care to survivors)
• 3. Short-term aftermath phase (from time rescue
  workers leave to time survivors fully process
  what has happened)
• 4. Long-term aftermath phase (from time survivors
  have at least temporarily adjusted to years after
  event or rest of life)

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Impact Phase

• During time that physical damage actually
• occurring
• 2. Hyper-arousal and alertness, followed by
  shock, numbness, and then in some, fear and panic
• 3. Primary need is information on how to minimize
  injury to person and damage to property
• Contact with emergency rescue workers is key
• along with practical assistance to escape

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Early Aftermath Phase

• From time that physical damage ends to end of
• time that rescue workers provide care (up to 1
  wk)
• 2. Physical needs are a priority psychosocial/
  spiritual needs often put on hold
• 3. Survivors may experience high anxiety, along
  with physiological responses (shaking, rapid
  pulse, need to use restroom) as shock wears off
  acute stress reactions
• 4. Need is simple explanations, instructions, and
  reassurance NO NEED FOR ADVICE or counseling
• 5. Need companionship someone who cares, and is
  willing to stand or sit silently with them,
  meeting basic needs

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Short-Term Aftermath Phase

• From time that rescuers leave scene to time that
• survivors fully process what happened its
  meaning
• (1-4 weeks to 6-12 months after disaster)
• Grieving over losses trying to piece back
  together their view of the world, achieve a sense
  of safety, predictability
• Now is when survivors most need emotional/social
  support and are receptive to it
• 4. Some may need professional psychological help
  to work through grief others need listening,
  caring ear
• 5. Many spiritual needs also present (next slide)

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Spiritual Needs Short-Term Aftermath

• Worldviews may be shaken. Attempts to
  reconstruct worldview. Is there a caring God who
  is in control?
• If in control, why did God allow this?
  Punishment?
• Is God present? Unable to feel distant,
  unconcerned
• Does God even exist? Dont want to believe in
  God who
• allowed this.
• Can I do something so God will allow my loved one
  to recover, me to regain my health, or prevent
  this from happening again? (repentance, penance,
  etc.)
• 6. Where is my faith community? (if not
  responding)
• 7. Need to verbalize doubts/anger simple answer
  not helpful

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Long-Term Aftermath Phase

• Begins 6-12 months after event (after temporary
  adjustment) after social and professional
  support ended continues for years, or rest of
  survivors life
• Seeking to achieve long-term adjustment, put life
  together rebuild
• Memorials and gatherings important, as
  anniversaries bring back pain/grief over the
  event
• Need periodic emotional/social/spiritual support
  for years
• Faith community ideally positioned to provide
  this ongoing emotional and practical support
  organize efforts to help survivor help others
  similarly affected, locally or at distance

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Negative Consequences of Disasters

• Without adequate social, psychological, and
  spiritual support, negative psychological
  consequences may result
• 1 in 3 survivors develop PTSD
• Chronic anxiety and/or depression (widespread)
• 4. Rescue workers also at risk (1 in 5 with PTSD)
• 5. At greatest risk
• - women, the young (or middle-aged with multiple
  roles)
• - those experiencing concurrent stressors
• - inadequate social support
• - low self-esteem
• - loss of faith

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Spiritual Injury and PTSD Symptoms
But, loss of faith is no laughing matter, as this
study shows 1,385 veterans from Vietnam (95),
World War II and/or Korea (5) involved in
outpatient or inpatient PTSD programs. VA
National Center for PTSD and Yale University
School of Medicine. Weakened religious faith was
an independent predictor of use of VA mental
health servicesindependent of severity of PTSD
symptoms and level of social functioning.
Investigators concluded that the use of mental
health services was driven more by their weakened
religious faith than by clinical symptoms or
social factors. Fontana, A., R. Rosenheck.
Trauma, change in strength of religious faith,
mental health service use among veterans treated
for PTSD. Journal of Nervous Mental Disease
2004 19257984.
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2. Religion and Coping with Stress

• Most information available from persons coping
  with stress of acute and chronic medical illness
• More limited data on persons coping with
  disasters and acts of terrorism

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Stress-induced Religious Coping
Americas Coping Response to Sept 11th 1.
Talking with others (98) 2. Turning to religion
(90) 3. Checked safety of family/friends
(75) 4. Participating in group activities
(60) 5. Avoiding reminders (watching TV)
(39) 6. Making donations (36)
Based on a random-digit dialing survey of the
U.S. on Sept 14-16
New England Journal of Medicine 2001
3451507-1512
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Religious Coping during Disasters (research
studies at individual level)
Natural disasters 1980 Midwest tornado 1989
Hurricane Hugo 1992 Hurricane Iniki 1993 Midwest
flood 1997 Hurricane Nigel 2001 Bhuj
earthquake Acts of War/Terrorism 1991 Gulf
War 1995 Oklahoma bombing 2001 World trade center
attacks 2000-2003 Israeli-Palestinian War see
In the Wake of Disaster (Templeton Press, 2006)
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Religion and Mental Health Research Before Year
2000

• Well-being, hope, and optimism (91/114)
• Purpose and meaning in life (15/16)
• Social support (19/20)
• Marital satisfaction and stability (35/38)
• Depression and its recovery (60/93)
• Suicide (57/68)
• Anxiety and fear (35/69)
• Substance abuse (98/120)
• Delinquency (28/36)
• Summary 478/724 quantitative studies
• Many new studies since 2000
• (see www.dukespiritualityandhealth.org)
• Handbook of Religion and Health (Oxford
  University Press, 2001)

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Cartoon with Prayzac
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In Conclusion

• Religious involvement is related to greater
  social support, better mental health, and faster
  adaptation
• Effects are strongest in those who have the
  greatest stress (consistent research finding)
• Religion is a powerful coping behavior that works
  best during uncontrollable stress, as that which
  occurs during disasters
• Besides individual effects of religion on coping,
  what role have the clergy and the faith community
  played in responding to disasters?

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3. Role of Faith Community in Preparing for and
Responding to Disasters
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Activities of Clergy/Faith Communities during
Disasters (research studies at community level)

• Natural disasters
• 1970 southwestern tornado
• 1974 Kentucky tornadoes
• 1985 West Virginia flood
• 1993 Midwest flood
• 1997 Tropical cyclone Martin
• 2005 Hurricane Katrina
• War and Terrorism
• 1995 Oklahoma City bombing
• 2001 World Trade Center attacks
• see In the Wake of Disaster (Templeton Press,
  2006)

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Faith Communities with Disaster Response Arms

• Every major religious denomination in the U.S.
  has one among the largest are
• Adventist Community Service
• American Baptist Men Disaster Relief
• Ananda Marga Universal Relief Team (Hindu)
• Catholic Charities Office of Disaster Response
• Christian Disaster Response
• Christian Reformed World Relief Committee
• Church of the Brethren Disaster Response
• Mormon Humanitarian Service
• Episcopal Relief and Development
• Friends Disaster Service
• International Aid (evangelical Christian)
• Lutheran Disaster Response
• Mennonite Disaster Service
• Nazarene Disaster Response
• Presbyterian Disaster Assistance
• Reformed Church World Service
• Salvation Army

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How do Individual Faith Communities Prepare for a
Disaster?

• Two-thirds of Americans are members of faith
  communities
• Faith communities, because of their religious
  beliefs, are naturally drawn to responding to
  those in need, both within and outside of their
  congregation
• Although most religious denominations already
  have disaster preparation and response arms, on
  the individual congregation level, little is
  being done in terms of preparation
• Unless preparation done, responses after disaster
  often weak and ineffective what should local
  religious congregations do to prepare?

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Preparing for Disaster What should faith
communities do?

• Have a town meeting with representatives of faith
  communities in the area
• Obtain info on and discuss the disaster risks in
  the area
• Develop a formal, written disaster plan (for each
  congregation and across congregations) make
  flexible
• Have a plan in place for taking care of the needs
  of the elderly and disabled, who may need special
  assistance
• Partner with formal emergency management services
  (EMS) and with voluntary disaster response groups
  attend at their planning meetings develop
  relationships
• Identify the special assets that the faith
  community (FC) possesses (and identify those that
  EMS and other disaster response groups possess)
• Develop an understanding with EMS groups on what
  the FCs specific role will be during disasters,
  based on the unique assets that it has (in
  coordination with others)

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Preparing for Disaster What should faith
communities do?

• Miscellaneous
• 8. Every 6-12 months, run through
  disaster-response plan as if a disaster has
  occurred so that kinks in plan are worked through
• 9. Have a stock-pile of canned goods, power
  supplies available in the church building, and
  have a contingency plan in place if the church
  building is destroyed by the disaster
• 10. Arrange a pact with another
  church/synagogue/mosque
• located in a different city to partner with in
  case one or the other is disabled
• 11. Identify a single person within each
  congregation to be point person to contact (and
  have a backup person also) these persons should
  have specialized disaster training a course on
  critical incident stress management and
  possibly seek certification
• 12. Identify persons within the faith community
  to serve as spiritual guides and counselors
  during a disaster, and train them to do so
  beforehand

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What Should Faith Communities do when a Disaster
Occurs (Response)

• When disaster occurs, point person in
  congregation is notified
• Point person initiates and executes the
  congregations disaster response plan
• Point person, who has a communications device
  unlikely to be disabled during a disasters,
  contacts others (church EMS)
• Elderly, disabled, other vulnerable persons
  attended to first next, members within
  congregation then, outside congregation
• Basic needs are met (rescue) and supplies are
  distributed (water, food, clothing, shelter)
• All of the above in coordination with local EMS
  services and ARC
• Assistance sought from denominational response
  arms, non-affected churches in community, partner
  church in other locale
• Finances raised, resources gathered, volunteers
  recruited
• After impact phase, volunteers provide
  companionship after early aftermath phase,
  provide support and more active psychological,
  social and spiritual support then, long-term
  support

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4. Role of the Aged and Disabled in Preparing
for, Responding to Disasters

• During disasters, the aged and disabled can be a
  huge burden
• Preparation beforehand, however, can make them a
  huge asset

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Role of the Aged and Disabled in Preparing for
Disasters

• 1. The aged and disabled have one thing that most
  others dont ---- time
• 2. The aged and disabled may also have other
  assets desire to make a difference, motivation
  for life to have meaning, and experience dealing
  with stress, trauma and tragedy
• Disaster preparation and training takes time and
  motivation to make a difference.when nothing is
  happening so, most healthy, independent, active
  people dont take time to do so
• This leave a big opening for the aged and
  disabled
• Of course, there are limitations need to be
  attended to

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Role of the Aged and Disabled in Preparing for
Disasters (cont)

• 1. The aged and disabled should be encouraged to
  obtain formal disaster training (read, watch
  video, take course over internet, take course in
  person)
• 2. At a minimum, they will learn how to prepare
  to be as little a burden as possible during a
  disaster (which itself will contribute
  meaningfully to disaster response)
• 3. At a maximum, they can help to coordinate the
  disaster response and serve as the point person
• 4. Most aged and disabled persons can do
  something in between 2 and 3 but they must be
  motivated and the SYSTEM must make room for them

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5. Coordinating the Faith Response

• Results of lack of coordination
• - duplication of services to some people
• - other people completely lacking services
• - competition/conflict with EMS (i.e.,
  well-meaning church people get in the way)
• - competition/conflict with other volunteers
  (religious non-religious)
• - anger, frustration, EMS complaining,
  volunteers quitting
• - harm done as people without training disturb
  disaster survivors by unneeded or misdirected
  helping, evangelizing, etc.
• Most of these can be avoided by preparation and
  coordination

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How to Coordinate?

• First, faith organizations and EMS groups need to
  learn what the other has to offer and appreciate
  and value it
• Then, they will WELCOME each other into their
  respective disaster preparation planning meetings
  and be included in overall formal disaster plans
  (which needs to occur)
• Thus, education on both sides is needed,
  especially awareness by traditional, formal EMS
  groups of what faith communities have to offer
• Faith communities, though, must assign and train
  leaders to participate in these planning meetings
  and give input
• What specific EMS groups need to include faith
  community representatives in their planning
  meetings?

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What EMS Groups Need Faith Community
Representatives at their Meetings

• Local immediate responders (police,
  fire-fighters, emergency medical technicians)
• City or county emergency management groups (run
  out of the mayors office)
• 3. State emergency management agencies (SEMA)
• 4. State mental health agencies (SMHA)
• 5. Federal emergency management agencies (FEMA)
• 6. American Red Cross (which has its own
  disaster spiritual care services, but this is
  highly limited, and may not want to share
  responsibilities)

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Dont Reinvent the Wheel
There already exists faith community coordinating
groups at the national level However, their
activity and effectiveness may not always be
optimal, and they may or may not have an impact
at the local level
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National Bodies Coordinating Faith-Based Disaster
Preparation and Response

• Church World Service Emergency Response Program
  (CWS)
• - 35 Protestant, Anglican, Orthodox bodies
• National Voluntary Organizations Active in
  Disasters (NVOAD)
• - 23 of its 35 member-organizations are
  religious bodies (including Catholic Charities,
  Lutheran Disaster Response, and Salvation Army)
• Action by Churches Together (ACT) International
• - works through 195 Protestant and Orthodox
  Churches around the world
• Association of Evangelical Relief Development
  Organizations (AERDO)
• - 45 evangelical Christian relief and
  development agencies

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Need for Coordination at the Local Level

• Again, dont reinvent the wheel. Local
  congregations in disaster-prone areas of the
  country have already gone through this
• Find out what they are doing, what they have
  tried, what has not worked and why.. and learn
  from their experiences
• Based on what they learn, faith communities
  should then strategize on how to best approach
  EMS agencies in their area and become more
  involved in formal disaster preparation and
  response plans
• All this must be done BEFORE a disaster strikes

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Summary

• Psychological and spiritual needs of disaster
  survivors and families depend on time after the
  event impact, early aftermath, short-term
  aftermath, and long-term aftermath phases
• Religious beliefs and practices are powerful and
  effective coping behaviors, especially during
  uncontrolled, severe stress
• Clergy and religious communities play key and
  critical roles in responding to disasters, and
  over the long haul, may be essential for
  community resilience
• The aged and disabled may be a huge asset during
  disaster, if they are adequately prepared
  beforehand
• Coordinating the disaster response is crucial,
  and faith community representatives should sit at
  the table with EMS planners and their roles
  written into disaster plans

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More Information

• In the Wake of Disaster Religious Responses to
  Terrorism Catastrophe (Templeton Press, 2006)
• http//www.templetonpress.org/book.asp?book_id84
  
• 2. Southern Medical Journal, September 2007
  issue, special section on Spirituality and
  Catastrophe
• http//www.sma.org/smj/
• 3. Developing a disaster plan for a congregation
• http//www.ldr.org/prepare/
• 4. More information on Spirituality and Health
• http//www.dukespiritualityandhealth.org