Supporting Community Health Workers after a Disaster: Findings from a Mixed-Methods Evaluation Study

Background: Disasters can impact an individual on many levels.  Loss of a home, devastation of a community, changes to the workplace or injuries and deaths of family and friends - these events are all too common in the wake of a disaster.  It can take months and even years to recover, which can lead to sustained chronic stress during the recovery process. Community health workers (CHWs) in disaster affected areas are at heightened risk for emotional distress, as they support others while they may be in the process of rebuilding their own lives.  They also often serve high need communities, where incomes are lower, health issues are elevated and health care is scarce.

The Resilience and Coping for the Healthcare Community (RCHC) intervention was developed in response to the stress CHWs faced after Hurricane Sandy in 2012.  The intervention uses psychoeducation with a group-practice approach to help participants: define types and dimensions of stress; identify stress responses experienced by healthcare professionals after a traumatic event; recognize signs of job burnout and compassion fatigue; identify healthy coping strategies that increase an individual's resilience following a traumatic event;  devise strategies to support each other in the workplace.

Methods:  A mixed methods pilot study on was RCHC conducted in 2013 with a convenience sample of staff from 6 federally qualified health centers (n=69).  Validated measures of stress, coping, compassion fatigue & satisfaction, burnout, stress, and social provisions, and a measure of perceived knowledge, were administered at baseline, post-workshop and at a 3-week follow-up.  Semi-structured interviews were conducted with a representative sample of 12 participants (drawn from 5 of the 6 sites) randomly selected participants and analyzed using content analysis. 

Results:  From baseline to post-workshop (n=69), perceived knowledge scores increased from 24.59 to 30.34, t(62)=5.16 (p<0.001), and acute stress scores decreased significantly from 10.53 to 6.78, t(64)=4.74 (p<0.001). Significant increases from baseline to three-week follow-up (n=56) were found for perceived knowledge (24.05 to 27.24), t(40)=5.37, p<0.001, and social provisions (27.34 to 28.39), t(44)=2.15, p<0.05. 

Qualitative findings indicated respondents valued learning about common stress responses and incorporating coping as part of a daily routine.  Team building and normalization of common disaster related emotions were seen as ancillary benefits that would reduce stress levels in the workplace. 

Implications:  Given the disproportionate risk for burnout and secondary trauma among CHWs it is critical for them to receive support in post-disaster contexts.  The findings suggest that the RCHC may be effective in reducing stress and enhancing coping capacity in this population of care providers.  Future RCT studies with larger samples in other post-disaster contexts should continue to investigate the impact of RCHC.