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Journal of Jewish Communal Service, Vol. 83, No.

1, Fall 2007

Trauma Response, Recovery, Planning, and Preparedness


Lessons Learned

Shelly Horwitz
Director of Grants & Management of the Caring Commission, UJA-Federation of New York

This article describes a strategic response by UJA-Federation of New York to


establish and fund the development of the Israel Trauma Coalition following the
eruption of the Al Akqsa intifada, the subsequent growth of binational relation-
ships, and the launching of joint projects by Israeli and American trauma service
providers within Israel, the United States, and internationally.

A fter the outbreak of the Al Akqsa in-


tifada, UJA-Federation of New York
made a strategic decision to establish and
In its formative stage the ITC had the
following goals:
• Building a national network of trained
fund a coalition of trauma-related service
trauma therapists and strengthening the
providers in Israel to strengthen the trauma
capacity of local networks to alleviate the
response capacity of the Israeli mental
suffering of victims of terrorism in highly
health system. The Israel Tramua Coali-
affected and underserved areas
tion's (ITC) purpose was to bring together
Israeli experts and organizations to create a • Facilitating trauma trainings throughout
cohesive continuum of trauma care in Is- the country for mental health profession-
rael. It has deployed a number of strategies als (social workers, psychologists, and
to advance the development of an inte- psychiatrists), primary care providers,
grated, coordinated, national system of psy- emergency workers, teachers, and volun-
chotrauma services that provide compre- teers
hensive care to prevent, identify, and treat • Increasing organizational capacity to
psychological trauma through clinical inter- train and deploy volunteers
ventions and community-based resilience • Using technological resources to expand
programs. access points
• Enhancing public education through me-
During its first few years, the ITC fo-
dia. Web sites, and outreach
cused on responding to immediate crisis
• Developing age-appropriate screening
needs by delivering direct services to terror
and assessment tools, curricula, proto-
victims, training service providers in spe-
cols, and interventions and improving
cific trauma interventions, and expanding
cultural competencies in service delivery
system capacity. Efforts were targeted to-
• Fostering binational collaborations, pro-
ward ensuring that trauma supports were
fessional exchanges, and shared learning
available to the more vulnerable segments
of the population, focusing in particular on A number of strategic initiatives were si-
schoolchildren. Holocaust survivors, and multaneously launched to increase system
new immigrants in addition to supporting capacity and strengthen cross-sector coordi-
first responders. nation, collaboration, and communication.

32
ISRAEL TRAUMA COALITION 33

Coalition members lent their expertise to This program, which has already been
spearheading select areas and forming in- implemented successfully in many schools
terest groups designed to engage a broad in Israel, New York, and elsewhere, places
range of community-based organizations, emphasis on specific components of resil-
renowned academic research institutions, ience. In the environment following the
and relevant government ministries around second Lebanon war in Israel, nongovern-
core needs. The primary interest groups mental organizations (NGOs) and the Edu-
were children and adolescents, school- cation Ministry's School Psychological Ser-
based interventions, emergency room/ vices Division (Shefi) are mobilizing to
primary care intervention, and community- deploy trained therapists to northern Israel
based interventions and resiliency. and quickly implement programs through-
out the schools. In the Gulf Coast region of
ISRAEL TRAUMA the United States, similar programs to train
COALITION INITIATIVES teachers to become "frontline responders"
are also being implemented.
Children: School-Based Interventions
Special efforts focused on children— Parental Psychoeducational and
traditionally both a vulnerable yet under- Coping Workshops
served segment of the population during
Families are extremely important systems
traumatic events and disasters. Schools of-
and constitute the most important unit for
ten constitute the most effective and cost-
post-disaster treatment and intervention ef-
efficient setting in which to provide pre-
forts. Families need concrete knowledge
and post-disaster mental health assistance
and skills to handle highly stressful situa-
to children and their families. "Schools as
tions and conflicts; to minimize negative en-
communities" can serve also as a natural,
counters caused by the strain, fatigue, and
familiar, and non-stigmatizing venue for
irritability that often follow trauma; and to
outreach to parents and as a natural setting
resume normal activities to the extent pos-
for facilitating the coordination of mental
sible. In the aftermath of trauma and disas-
health, health, social, and educational re-
ter, substance abuse and family violence
sources.
frequently increase, especially when eco-
The goal of this resiliency project is to nomic stability is also at risk. By definition,
equip parents, teachers, and guidance coun- disasters result in economic disruption and
selors with the knowledge and skills to iden- are beyond the capacity of the affected lo-
tify those at risk and, where possible, pre- cality to successfully manage alone. Recog-
vent distress symptoms. For those children nizing the importance of supporting fami-
in need of treatment for posttraumatic lies, coalition members offer workshops for
stress, school professionals gain both an ex- parents in affected communities consisting
panded capacity to respond more effec- of both psychoeducation and skill-building
tively by supporting and enhancing the activities designed to strengthen their cop-
child's natural resiliency and the awareness ing abilities.
of additional resources if needed. Extensive
screening was conducted in preschools, el-
Trauma Training for Medical Personnel
ementary, and high schools to identify chil-
and Community-Based Primary
dren and adolescents suffering from or at
Care Providers
high risk of posttraumatic stress disorders.
Screening instruments and a core curriculum, During the intifada, as hundreds of psy-
using best-practice treatment methodolo- chological victims flooded hospital emer-
gies and adapted to differing developmental gency rooms after each horrific suicide
needs, were developed in collaboration bombing, the first phase of this project fo-
with UJA-Federation agencies. cused on developing emergency room pro-

Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007


34 JOURNAL OF JEWISH COMMUNAL SERVICE

tocols and conducting an intensive training Walk-in-Crisis Center


course for ER physicians to increase their
ability to identify and respond effectively to During the period of heightened terror
Acute Stress Disorder (ASD) and Acute attacks in 2002, UJA-Federation of NY also
Stress Reactions (ASR). An ASR screening funded Metiv, Israel's first crisis walk-in
tool was created, as was an ASD best- center. In the aftermath of the war with
practice protocol. In the second phase, Hezbollah, when 400,000 people were dis-
other medical personnel received training placed and only the most vulnerable citi-
in trauma interventions. More than 700 zens were left in northern communities, the
staff, from most of the 22 general hospitals ITC recognized the extensive need for psy-
throughout Israel, have received training in chological counseling. UJA-Federation of
using the ASR protocol. In this initiative NY recently allocated funds to open a walk-
contact was maintained with discharged pa- in center in Kiryat Shemona, modeled on
tients to provide follow-up and monitoring the one in Metiv.
for potential emergence of posttrauma
symptoms to prevent posttraumatic stress Vulnerable Populations
disorder (PTSD).
A major thrust of the ITC has been to
Helping the Helpers increase access points and enhance services
for people with disabilities, Holocaust sur-
ITC's development of flexible and adapt- vivors, and new immigrants. Emotional and
able "helping the helper" (HTH) protocols concrete supports are available for those
has been an important initiative directed to- who have been injured or lost loved ones.
ward first responders, emergency workers, Healing retreats have helped hundreds of
bus drivers, mental health professionals, bereaved Israelis. The strong tradition of
and volunteers who are often over-
volunteerism in Israeli society has also
extended for prolonged periods of time and
served to expand system capacity to care for
are at risk for secondary traumatization and
those in need.
burnout. Worldwide, 16% of first respond-
ers suffer from ongoing and debilitating
posttraumatic stress. The aim of HTH is to City-Wide Models of Community
make group, family, and individual inter- Intervention and Preparedness
ventions automatically available to front- Access to information and knowledge is a
line first responders and their families im- key component of successful healing and re-
mediately after a traumatic incident and for covery, as is a having a predicable sense of
18 months after the event. the future and an active role in problem
The next stage in the expansion of the resolution. After disastrous events, survi-
first responder project sought to build ca- vors benefit from a group recovery process
pacity within each of the participating na- that serves to lessen isolation and contrib-
tional organizations (police and fire depart- utes toward building cohesive communities.
ments; Hatzolah—a volunteer emergency Convening community forums and design-
medical service; Magen David Adom— ing group interventions allow for identify-
Israel's emergency medical, disaster, ing mutual areas of concerns, help empower
ambulance, and blood bank service; and communities, and foster a stronger sense of
ZAKA— a religious voluntary organization caring community at the local level. Mass
responsible for recovery and identification disaster literature shows that feelings of so-
of body parts in order to fulfill the Jewish cial support and social embeddedness ap-
burial imperative), with the goal of embed- pear to be especially vulnerable to the im-
ding knowledge and coping strategies while pact of disasters. With few exceptions,
recognizing that each possesses a unique disaster survivors who believe they will be
culture. cared for and that help will be available fare

Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007


ISRAEL TRAUMA COALITION 35

better psychologically than survivors who with United Jewish Communities, the
feel they are alone in their struggle. Jewish Agency, and other North Ameri-
The best strategy for community building can federations and Jewish family service
is a community empowerment approach agencies
that views community members as partners • Becoming a pivotal provider of trauma-
and capitalizes on their various strengths, related services and convener of planning
assets, expertise, and organizational capac- tables
ity. This "community as partner" approach • Launching of international humanitarian
appreciates that members of the affected responses (Sri Lanka, Beslan, Russia,
communities are key to developing effec- London, Katrina)
tive strategies for dealing with problems • International recognition of its expertise
and can benefit from additional resources. in trauma response and disaster pre-
Understanding the importance of strength- paredness
ening communities, the ITC has served as a
convener by bringing stakeholders—local
BINATIONAL COLLABORATION
municipalities, the Jewish Agency for Is-
AND MODEL DEVELOPMENT
rael, and the American Jewish Joint Distri-
bution Committee—together with the goal The 9/11 attack prompted the interna-
of developing interdisciplinary teams to fos- tionalization of the concept of cooperative
ter integrative service delivery between ex- trauma service coordination, as New York
isting systems of care. Planning forums de- UJA-Federation network agencies and the
signed to develop comprehensive, city-wide ITC began an intensive bilateral exchange
models of trauma response, intervention, of knowledge and launched collaborative
and resilience building programs are under- projects, creating a community of interests
way in Jerusalem, Netanya, Sderot, and between experts and agencies in New York
Afula. This model of community-building and Israel. A shared long-term strategic vi-
is being replicated with local councils sion was developed through a series of fo-
throughout the north to help in the recon- rums, binational exchanges, conferences,
struction. and video-conferences.
The binational collaboration has resulted
ITC ACCOMPLISHMENTS
in the development of field-tested evidence-
Since its embryonic beginnings, the Israel based intervention models and has led to
Trauma Coalition (ITC) has grown from a the creation of shared screening and diag-
group of 7 organizations to more than 40 nostic tools, treatment manuals, and inter-
participating agencies and has gained rec- ventions. Israeli experts have conducted
ognition for its unique contributions. Among trainings in specific areas of expertise
the ITC's accomplishments over the past throughout the United States, and their
five years are the following: American counterparts have traveled to Is-
• Creation of a coalition of specialized rael to conduct professional training. This
trauma organizations in Israel unique partnership and knowledge transfer
• Development of strong relationships with have stimulated the development of new
the Israeli Ministries of Health, Educa- public health models that combine clinical
tion, Welfare and National Insurance and and community-based interventions.
the Prime Minister's Office of Homeland The binational alliance among UJA-
Security Federation, its network of agencies, and the
• After 9/11, development of binational ITC has served to strengthen the bonds be-
collaborations between the ITC and tween the New York Jewish community
UJA-Federation of NY's network agen- and Israelis. Many American professionals
cies. have established or deepened professional
• Forging of partnerships/collaborations connections in Israel. They have contrib-

Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007


36 JOURNAL OF JEWISH COMMUNAL SERVICE

uted expertise, expanded knowledge by ing to trauma and disaster. Investment in a


learning from a country living with ongoing high-level binational team of experts cre-
terrorism, field-tested concepts with the po- ates a dynamic opportunity for the world-
tential to advance the field of trauma ser- wide Jewish community to develop an ad-
vices, and reinforced the concept of icoi ara- ditional resource that can be deployed
vim zeh I'zeh—that all Jews are responsible flexibly in future disasters.
for one another. Among the benefits for Is-
raelis are the following: the influx of finan- The Gnlf Region:
cial resources; the additive perspective of A Global Jewish Response
"outside eyes," which can be helpful in miti-
gating the frequent tendency of trauma Americans and much of the world viewed
and crisis professionals to become over- with shock the catastrophe that unfolded in
involved; a sense of connection and psycho- the aftermath of Hurricane Katrina when
logical support that help counteract the iso- the levees broke and a vast segment of the
lation associated with coping with life- population of New Orleans could not es-
threatening circumstances; professional cape the danger. Those trapped were pri-
development opportunities; and enhance- marily poor and without means of transpor-
ment of existing services. tation. The human tragedy that followed in
Cornerstones of the binational collabora- the Superdome and the New Orleans Con-
tion have been shared learning and a strong vention Center demonstrated the high hu-
sense of mutuality. This sense of mutual in- man costs of the collective failure to have
vestment and identification has contributed adequate governmental resources in place
to the building of a collective vision de- prior to and immediately after a massive
signed to capitalize on various strengths, as- disaster. These catastrophic disasters in the
sets, expertise, organizational capacities, Gulf region have highlighted the immediacy
and resources. of the need to address not only the physical
needs of disaster victims but also to increase
national capacity to prevent, identify, and
International Partnership Opportunities treat the psychological effects of disaster. In
addition, it emphasized the need for an on-
Creating an integrated team of trauma
going planning process that brings together
professionals from Israel and the United
the resources of government, philanthropy,
States as part of an international Jewish re-
and the human services sector in effective
sponse to disasters serves the interests of
public-private partnerships. Katrina cata-
both Israelis and American Jews. The de-
pulted painfully the nation's vulnerability to
ployment of Israelis and American Jews to
disasters—natural or man-made—into the
Sri Lanka following the tsunami and to
public consciousness.
the Gulf region after Hurricane Katrina
positively demonstrated the Jewish com- The ITC and UJA-Federation agencies
mitment to tikkun oiam worldwide by have brought their accumulated knowledge
supporting transformative and innovative of working with disaster victims to the Gulf
approaches to humanitarian crisis. The Coast to assist the thousands of people af-
value of the Jewish community's visible par- fected. Together, they are applying lessons
ticipation in recovery efforts around the learned to strengthen local trauma service
world should not be underestimated. capacity within existing frameworks, such
The creation of binational or interna- as schools and the public health care sys-
tional teams of trauma specialists that can tem. Building on the "schools as a commu-
together respond in areas touched by trau- nity" model, synagogues, Hillels, and Jew-
matic events serves to strengthen our own ish Community Centers are natural gateway
communal bonds and further concretizes institutions that can easily be mobilized fol-
the sharing of methodologies for respond- lowing a crisis to aid in recovery. The ex-

Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007


ISRAEL TRAUMA COALITION 37

traordinary response of Jewish college partners with the government in providing a


students throughout the country who vol- more effective response that ensures
unteered during their school breaks (as well prompt relief in a major national disaster.
as other members of the Jewish commu- Our community has a long history of suc-
nity) to assist in rebuilding homes along the cessfully forming public-private partner-
Gulf Coast is evidence of the power of vol- ships. Federations should therefore take a
unteerism and our community's commit- visible role in responding to large-scale
ment to helping untold others beyond our public emergencies. The resources of our
own community. federated system can be mobilized flexibly
and quickly, and pre-existing response
LESSONS LEARNED: STRATEGIES plans will enable more efficient models of
FOR MOVING FORWARD—IT'S A communication, collaboration, and coordi-
SMALL WORLD AFTER ALL nation in emergency situations. Federations
throughout the country need to develop a
Over the past few years, world events pragmatic response that will take into ac-
ranging from the intifada, 9/11, the South count lessons learned from the lack of pre-
Asian tsunami, the earthquake in Pakistan, paredness for the September 11 attacks and
the destruction wrought by Hurricanes Ka- the impact of damaging hurricanes by thor-
trina, Rita, and Wilma, and the subway oughly assessing the strengths and deficits
bombings in Europe to the attacks on Jew- of our system, mapping assets and re-
ish institutions in France, Tunisia, Turkey, sources, educating communities, and orga-
and the United War, as well as the recent nizing professional workgroups to develop
war in Israel, have intensified awareness of coordinated regional response networks
the importance of trauma supports, disaster that are trained and prepared for crisis re-
preparedness, and crisis response. Knowing sponse and contingency planning. An an-
that disaster can strike anyone, at any time nual track devoted to emergency planning
and anywhere, it is incumbent on our sys- at the General Assembly would be one ve-
tem to develop comprehensive prepared- hicle for highlighting best practices.
ness plans that build on lessons learned
from previous crisis. Trauma and disaster services have his-
torically been highly fragmented. Service
In the face of worldwide terrorism and
providers tend to specialize in unique as-
natural disasters, enhancing the psychologi-
cal security of children and families is inte- pects of trauma care, rather than in a holis-
gral to preserving psychosocial security and tic approach that brings together a collec-
effectively strengthening the fabric of soci- tive knowledge base, expertise, and
ety. The aftermath of 9/11 revealed critical integrated planning, A comprehensive
gaps in the preparedness of the U.S. public model that includes preparedness, preven-
health system to manage large-scale terror- tion, mitigation, intervention, and recovery
ist attacks. More recently, the catastrophic provides the philosophical framework that
disasters in the Gulf region have exposed has informed UJA-Federation's strategic
the immediacy of the need to proactively approach. The collective expertise, knowl-
develop plans to increase the national ca- edge, and experience of our federation sys-
pacity to prevent, identify, and treat the tem can be brought to bear systemically to
psychological effects of disaster. Local, strategically plan a coordinated response to
state, and federal governments working crisis.
with community-based organizations can From disaster and tragedy new opportu-
design an efficient coordinated system to nities emerge. It has often been referred to
meet basic needs and address disbursement as "finding the gift in the horror," Oppor-
of resources in a national disaster. Commu- tunities for collaboration and communal
nity and faith-based organizations are key planning on local, national, and interna-

Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007


38 JOURNAL OF JEWISH COMMUNAL SERVICE

tional levels arise that can be actualized to fice for being instrumental in the development and
strengthen response systems. Creating a launching of the Trauma Coahtion; and Dr. Danny
Brom, Tali Levanon, and the members of the Israel
trauma coalition provided the vehicle to
Trauma Coalition for their commitment and dedi-
maximize system capacity, thereby improv- cation to this endeavor.
ing the mental health and social outcomes
for increasing numbers of Israelis at risk for
posttraumatic stress conditions. Drawing
REFERENCES
from the lessons learned from our work in Chemtob, C. M. (2002, May). A public health ap-
Israel, the federation system is well posi- proach to disaster recovery and preparedness. Pa-
tioned to use its wealth of resources to de- per presented at the Health Promotion Confer-
velop and maintain a comprehensive and ence, New York Academy of Medicine and New
York City Department of Public Health, New
sophisticated model of disaster planning York.
and emergency response. Chemtob, C. M. (2002, June 30). Effective child
trauma treatment: Integrating public health and
ACKNOWLEDGMENTS clinical approaches. Paper presented at First Bi-
National Child Trauma Treatment Conference,
UJA-Federation is grateful to Dr. Claude Chem- Jerusalem.
tob. Professor of Psychiatry and Pediatrics at Mount Horwitz, S., & Leiner, R. (2003). Non-traditional
Sinai Medical Center, for serving as advisor and for first responders: Roles, challenges and opportu-
ideas that are reflected in the trauma initiatives; nities for Jewish communal professionals re-
Roberta Leiner, UJA-Federation of NY and Eli- sponding to emergencies. Journal of Jewish
sheva Flamm-Oren of UJA-Federation's Israel of- Communal Service.

Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007