Saturday, 15 January 2005 - 4:00 PM

This presentation is part of: Community Trauma and Access to Mental Health Care: Using Mixed Methodology to Uncover Need, Barriers and Innovative Pathways

When Disaster Strikes in Unprecedented Ways: Evaluating a Culturally Sensitive Psychoeducational Group Intervention During a National Crisis

Purpose: September 11th transformed New York City into a community united by a common tragedy. The tragedy prompted an urgent need to 1) educate the general public and the mental health community about the impact of exposure to trauma and 2) implement effective strategies for intervention and prevention. With few models to rely on, social workers played a pivotal role, responding to overwhelming need, especially among those with limited access to mental health care because of linguistic and cultural barriers, and stigma. In this context, we developed Healthy Outreach through Psychoeducation (HOPE-NY) in partnership with community based agencies in diverse settings to create, implement, and evaluate a short term (four-session) group intervention grounded in the evidence based principles of psychoeducation. The findings presented here focus on the formative and summative evaluation data.

Method: Using strategies for participatory action research we collaborated with six community based agencies in New York City serving the Arab, Chinese, Dominican, Native American, Puerto Rican or union members working at Ground Zero. Because of both the complexity of delivering care during a crisis and funding stipulations, we selected an evaluation design over a formal research design. Using a mixed-method approach we evaluated implementation as well as service effectiveness. We compiled field notes from focus groups, planning and curriculum development meetings and training sessions as well as quantitative measures of demographics, event response and satisfaction measures. We used Atlas.ti to manage and analyze the qualitative data, and grounded theory and an iterative process of analysis to further understand how trauma affected the communities, agency staff, and community members. The thematic content analysis allowed us in turn to modify the curriculum, recruitment, and delivery and timing of the intervention. In all, we conducted 11 focus groups representing 48 providers and 33 community members. The formative evaluation, coupled with the summative satisfaction and event response data collected among clients who completed the psychoeducational groups (n =144), provide a preliminary view of project implementation and impact.

Results: Through the qualitative analysis several central psychoeducational domains emerged including 1) negative and positive impacts of community trauma, 2) loss and post-traumatic growth, 3) planning ahead and creating safety, and 4) care for self, family and community. We then collaborated with each community to adapt the four key areas using culturally and linguistically relevant implementation strategies. Both group leaders and members reported satisfaction with their participation and stressed that the psychoeducational group process had been relevant as regards traumatic experience, language and culture. A majority of client participants (87%) credited the HOPE-NY group with reducing fears and barriers to accessing other psychosocial programs.

Implication for Practice: HOPE-NY developed a brief manual-based group psychoeducational intervention targeting underserved ethnic communities. Cooperation among investigators, providers and participants from each community served as a bridge for participants to gain access to appropriate services. Disaster interventions that rely on formal mental health methods risk rejection by intended recipients and may deprive them of needed services. HOPE-NY offers a flexible model responsive to diversity and unique reactions to trauma.

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