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

32
 ISRAEL TRAUMA COALITION
Coalition members lent their expertise to
spearheading select areas and forming in-
terest groups designed to engage a broad
range of community-based organizations,
renowned academic research institutions,
and relevant government ministries around
core needs. The primary interest groups
were children and adolescents, school-
based interventions, emergency room/
primary care intervention, and community-
based interventions and resiliency.
ISRAEL TRAUMA
COALITION INITIATIVES
Children: School-Based Interventions
Special efforts focused on children—
traditionally both a vulnerable yet under-
served segment of the population during
traumatic events and disasters. Schools of-
ten constitute the most effective and cost-
efficient setting in which to provide pre-
and post-disaster mental health assistance
to children and their families. "Schools as
communities" can serve also as a natural,
familiar, and non-stigmatizing venue for
outreach to parents and as a natural setting
for facilitating the coordination of mental
health, health, social, and educational re-
sources.
The goal of this resiliency project is to
equip parents, teachers, and guidance coun-
selors with the knowledge and skills to iden-
tify those at risk and, where possible, pre-
vent distress symptoms. For those children
in need of treatment for posttraumatic
stress, school professionals gain both an ex-
panded capacity to respond more effec-
tively by supporting and enhancing the
child's natural resiliency and the awareness
of additional resources if needed. Extensive
screening was conducted in preschools, el-
ementary, and high schools to identify chil-
dren and adolescents suffering from or at
high risk of posttraumatic stress disorders.
Screening instruments and a core curriculum,
using best-practice treatment methodolo-
gies and adapted to differing developmental
needs, were developed in collaboration
with UJA-Federation agencies.
Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007
33
This program, which has already been
implemented successfully in many schools
in Israel, New York, and elsewhere, places
emphasis on specific components of resil-
ience. In the environment following the
second Lebanon war in Israel, nongovern-
mental organizations (NGOs) and the Edu-
cation Ministry's School Psychological Ser-
vices Division (Shefi) are mobilizing to
deploy trained therapists to northern Israel
and quickly implement programs through-
out the schools. In the Gulf Coast region of
the United States, similar programs to train
teachers to become "frontline responders"
are also being implemented.
Parental Psychoeducational and
Coping Workshops
Families are extremely important systems
and constitute the most important unit for
post-disaster treatment and intervention ef-
forts. Families need concrete knowledge
and skills to handle highly stressful situa-
tions and conflicts; to minimize negative en-
counters caused by the strain, fatigue, and
irritability that often follow trauma; and to
resume normal activities to the extent pos-
sible. In the aftermath of trauma and disas-
ter, substance abuse and family violence
frequently increase, especially when eco-
nomic stability is also at risk. By definition,
disasters result in economic disruption and
are beyond the capacity of the affected lo-
cality to successfully manage alone. Recog-
nizing the importance of supporting fami-
lies, coalition members offer workshops for
parents in affected communities consisting
of both psychoeducation and skill-building
activities designed to strengthen their cop-
ing abilities.
Trauma Training for Medical Personnel
and Community-Based Primary
Care Providers
During the intifada, as hundreds of psy-
chological victims flooded hospital emer-
gency rooms after each horrific suicide
bombing, the first phase of this project fo-
cused on developing emergency room pro-
34 JOURNAL OF JEWISH COMMUNAL SERVICE
tocols and conducting an intensive training
course for ER physicians to increase their
ability to identify and respond effectively to
Acute Stress Disorder (ASD) and Acute
Stress Reactions (ASR). An ASR screening
tool was created, as was an ASD best-
practice protocol. In the second phase,
other medical personnel received training
in trauma interventions. More than 700
staff, from most of the 22 general hospitals
throughout Israel, have received training in
using the ASR protocol. In this initiative
contact was maintained with discharged pa-
tients to provide follow-up and monitoring
for potential emergence of posttrauma
symptoms to prevent posttraumatic stress
disorder (PTSD).
Helping the Helpers
ITC's development of flexible and adapt-
able "helping the helper" (HTH) protocols
has been an important initiative directed to-
ward first responders, emergency workers,
bus drivers, mental health professionals,
and volunteers who are often over-
extended for prolonged periods of time and
are at risk for secondary traumatization and
burnout. Worldwide, 16% of first respond-
ers suffer from ongoing and debilitating
posttraumatic stress. The aim of HTH is to
make group, family, and individual inter-
ventions automatically available to front-
line first responders and their families im-
mediately after a traumatic incident and for
18 months after the event.
The next stage in the expansion of the
first responder project sought to build ca-
pacity within each of the participating na-
tional organizations (police and fire depart-
ments; Hatzolah—a volunteer emergency
medical service; Magen David Adom—
Israel's emergency medical, disaster,
ambulance, and blood bank service; and
ZAKA— a religious voluntary organization
responsible for recovery and identification
of body parts in order to fulfill the Jewish
burial imperative), with the goal of embed-
ding knowledge and coping strategies while
recognizing that each possesses a unique
culture.
Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007
Walk-in-Crisis Center
During the period of heightened terror
attacks in 2002, UJA-Federation of NY also
funded Metiv, Israel's first crisis walk-in
center. In the aftermath of the war with
Hezbollah, when 400,000 people were dis-
placed and only the most vulnerable citi-
zens were left in northern communities, the
ITC recognized the extensive need for psy-
chological counseling. UJA-Federation of
NY recently allocated funds to open a walk-
in center in Kiryat Shemona, modeled on
the one in Metiv.
Vulnerable Populations
A major thrust of the ITC has been to
increase access points and enhance services
for people with disabilities, Holocaust sur-
vivors, and new immigrants. Emotional and
concrete supports are available for those
who have been injured or lost loved ones.
Healing retreats have helped hundreds of
bereaved Israelis. The strong tradition of
volunteerism in Israeli society has also
served to expand system capacity to care for
those in need.
City-Wide Models of Community
Intervention and Preparedness
Access to information and knowledge is a
key component of successful healing and re-
covery, as is a having a predicable sense of
the future and an active role in problem
resolution. After disastrous events, survi-
vors benefit from a group recovery process
that serves to lessen isolation and contrib-
utes toward building cohesive communities.
Convening community forums and design-
ing group interventions allow for identify-
ing mutual areas of concerns, help empower
communities, and foster a stronger sense of
caring community at the local level. Mass
disaster literature shows that feelings of so-
cial support and social embeddedness ap-
pear to be especially vulnerable to the im-
pact of disasters. With few exceptions,
disaster survivors who believe they will be
cared for and that help will be available fare
 ISRAEL TRAUMA COALITION
better psychologically than survivors who
feel they are alone in their struggle.
The best strategy for community building
is a community empowerment approach
that views community members as partners
and capitalizes on their various strengths,
assets, expertise, and organizational capac-
ity. This "community as partner" approach
appreciates that members of the affected
communities are key to developing effec-
tive strategies for dealing with problems
and can benefit from additional resources.
Understanding the importance of strength-
ening communities, the ITC has served as a
convener by bringing stakeholders—local
municipalities, the Jewish Agency for Is-
rael, and the American Jewish Joint Distri-
bution Committee—together with the goal
of developing interdisciplinary teams to fos-
ter integrative service delivery between ex-
isting systems of care. Planning forums de-
signed to develop comprehensive, city-wide
models of trauma response, intervention,
and resilience building programs are under-
way in Jerusalem, Netanya, Sderot, and
Afula. This model of community-building
is being replicated with local councils
throughout the north to help in the recon-
struction.
ITC ACCOMPLISHMENTS
Since its embryonic beginnings, the Israel
Trauma Coalition (ITC) has grown from a
group of 7 organizations to more than 40
participating agencies and has gained rec-
ognition for its unique contributions. Among
the ITC's accomplishments over the past
five years are the following:
• Creation of a coalition of specialized
trauma organizations in Israel
• Development of strong relationships with
the Israeli Ministries of Health, Educa-
tion, Welfare and National Insurance and
the Prime Minister's Office of Homeland
Security
• After 9/11, development of binational
collaborations between the ITC and
UJA-Federation of NY's network agen-
cies.
• Forging of partnerships/collaborations
Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007
35
with United Jewish Communities, the
Jewish Agency, and other North Ameri-
can federations and Jewish family service
agencies
• Becoming a pivotal provider of trauma-
related services and convener of planning
tables
• Launching of international humanitarian
responses (Sri Lanka, Beslan, Russia,
London, Katrina)
• International recognition of its expertise
in trauma response and disaster pre-
paredness
BINATIONAL COLLABORATION
AND MODEL DEVELOPMENT
The 9/11 attack prompted the interna-
tionalization of the concept of cooperative
trauma service coordination, as New York
UJA-Federation network agencies and the
ITC began an intensive bilateral exchange
of knowledge and launched collaborative
projects, creating a community of interests
between experts and agencies in New York
and Israel. A shared long-term strategic vi-
sion was developed through a series of fo-
rums, binational exchanges, conferences,
and video-conferences.
The binational collaboration has resulted
in the development of field-tested evidence-
based intervention models and has led to
the creation of shared screening and diag-
nostic tools, treatment manuals, and inter-
ventions. Israeli experts have conducted
trainings in specific areas of expertise
throughout the United States, and their
American counterparts have traveled to Is-
rael to conduct professional training. This
unique partnership and knowledge transfer
have stimulated the development of new
public health models that combine clinical
and community-based interventions.
The binational alliance among UJA-
Federation, its network of agencies, and the
ITC has served to strengthen the bonds be-
tween the New York Jewish community
and Israelis. Many American professionals
have established or deepened professional
connections in Israel. They have contrib-
36 JOURNAL OF JEWISH COMMUNAL SERVICE
uted expertise, expanded knowledge by
learning from a country living with ongoing
terrorism, field-tested concepts with the po-
tential to advance the field of trauma ser-
vices, and reinforced the concept of icoi ara-
vim zeh I'zeh—that all Jews are responsible
for one another. Among the benefits for Is-
raelis are the following: the influx of finan-
cial resources; the additive perspective of
"outside eyes," which can be helpful in miti-
gating the frequent tendency of trauma
and crisis professionals to become over-
involved; a sense of connection and psycho-
logical support that help counteract the iso-
lation associated with coping with life-
threatening circumstances; professional
development opportunities; and enhance-
ment of existing services.
Cornerstones of the binational collabora-
tion have been shared learning and a strong
sense of mutuality. This sense of mutual in-
vestment and identification has contributed
to the building of a collective vision de-
signed to capitalize on various strengths, as-
sets, expertise, organizational capacities,
and resources.
International Partnership Opportunities
Creating an integrated team of trauma
professionals from Israel and the United
States as part of an international Jewish re-
sponse to disasters serves the interests of
both Israelis and American Jews. The de-
ployment of Israelis and American Jews to
Sri Lanka following the tsunami and to
the Gulf region after Hurricane Katrina
positively demonstrated the Jewish com-
mitment to tikkun oiam worldwide by
supporting transformative and innovative
approaches to humanitarian crisis. The
value of the Jewish community's visible par-
ticipation in recovery efforts around the
world should not be underestimated.
The creation of binational or interna-
tional teams of trauma specialists that can
together respond in areas touched by trau-
matic events serves to strengthen our own
communal bonds and further concretizes
the sharing of methodologies for respond-
Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007
ing to trauma and disaster. Investment in a
high-level binational team of experts cre-
ates a dynamic opportunity for the world-
wide Jewish community to develop an ad-
ditional resource that can be deployed
flexibly in future disasters.
The Gnlf Region:
A Global Jewish Response
Americans and much of the world viewed
with shock the catastrophe that unfolded in
the aftermath of Hurricane Katrina when
the levees broke and a vast segment of the
population of New Orleans could not es-
cape the danger. Those trapped were pri-
marily poor and without means of transpor-
tation. The human tragedy that followed in
the Superdome and the New Orleans Con-
vention Center demonstrated the high hu-
man costs of the collective failure to have
adequate governmental resources in place
prior to and immediately after a massive
disaster. These catastrophic disasters in the
Gulf region have highlighted the immediacy
of the need to address not only the physical
needs of disaster victims but also to increase
national capacity to prevent, identify, and
treat the psychological effects of disaster. In
addition, it emphasized the need for an on-
going planning process that brings together
the resources of government, philanthropy,
and the human services sector in effective
public-private partnerships. Katrina cata-
pulted painfully the nation's vulnerability to
disasters—natural or man-made—into the
public consciousness.
The ITC and UJA-Federation agencies
have brought their accumulated knowledge
of working with disaster victims to the Gulf
Coast to assist the thousands of people af-
fected. Together, they are applying lessons
learned to strengthen local trauma service
capacity within existing frameworks, such
as schools and the public health care sys-
tem. Building on the "schools as a commu-
nity" model, synagogues, Hillels, and Jew-
ish Community Centers are natural gateway
institutions that can easily be mobilized fol-
lowing a crisis to aid in recovery. The ex-
 ISRAEL TRAUMA COALITION
traordinary response of Jewish college
students throughout the country who vol-
unteered during their school breaks (as well
as other members of the Jewish commu-
nity) to assist in rebuilding homes along the
Gulf Coast is evidence of the power of vol-
unteerism and our community's commit-
ment to helping untold others beyond our
own community.
LESSONS LEARNED: STRATEGIES
FOR MOVING FORWARD—IT'S A
SMALL WORLD AFTER ALL
Over the past few years, world events
ranging from the intifada, 9/11, the South
Asian tsunami, the earthquake in Pakistan,
the destruction wrought by Hurricanes Ka-
trina, Rita, and Wilma, and the subway
bombings in Europe to the attacks on Jew-
ish institutions in France, Tunisia, Turkey,
and the United War, as well as the recent
war in Israel, have intensified awareness of
the importance of trauma supports, disaster
preparedness, and crisis response. Knowing
that disaster can strike anyone, at any time
and anywhere, it is incumbent on our sys-
tem to develop comprehensive prepared-
ness plans that build on lessons learned
from previous crisis.
In the face of worldwide terrorism and
natural disasters, enhancing the psychologi-
cal security of children and families is inte-
gral to preserving psychosocial security and
effectively strengthening the fabric of soci-
ety. The aftermath of 9/11 revealed critical
gaps in the preparedness of the U.S. public
health system to manage large-scale terror-
ist attacks. More recently, the catastrophic
disasters in the Gulf region have exposed
the immediacy of the need to proactively
develop plans to increase the national ca-
pacity to prevent, identify, and treat the
psychological effects of disaster. Local,
state, and federal governments working
with community-based organizations can
design an efficient coordinated system to
meet basic needs and address disbursement
of resources in a national disaster. Commu-
nity and faith-based organizations are key
Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007
37
partners with the government in providing a
more effective response that ensures
prompt relief in a major national disaster.
Our community has a long history of suc-
cessfully forming public-private partner-
ships. Federations should therefore take a
visible role in responding to large-scale
public emergencies. The resources of our
federated system can be mobilized flexibly
and quickly, and pre-existing response
plans will enable more efficient models of
communication, collaboration, and coordi-
nation in emergency situations. Federations
throughout the country need to develop a
pragmatic response that will take into ac-
count lessons learned from the lack of pre-
paredness for the September 11 attacks and
the impact of damaging hurricanes by thor-
oughly assessing the strengths and deficits
of our system, mapping assets and re-
sources, educating communities, and orga-
nizing professional workgroups to develop
coordinated regional response networks
that are trained and prepared for crisis re-
sponse and contingency planning. An an-
nual track devoted to emergency planning
at the General Assembly would be one ve-
hicle for highlighting best practices.
Trauma and disaster services have his-
torically been highly fragmented. Service
providers tend to specialize in unique as-
pects of trauma care, rather than in a holis-
tic approach that brings together a collec-
tive knowledge base, expertise, and
integrated planning, A comprehensive
model that includes preparedness, preven-
tion, mitigation, intervention, and recovery
provides the philosophical framework that
has informed UJA-Federation's strategic
approach. The collective expertise, knowl-
edge, and experience of our federation sys-
tem can be brought to bear systemically to
strategically plan a coordinated response to
crisis.
From disaster and tragedy new opportu-
nities emerge. It has often been referred to
as "finding the gift in the horror," Oppor-
tunities for collaboration and communal
planning on local, national, and interna-
38 JOURNAL OF JEWISH COMMUNAL SERVICE
tional levels arise that can be actualized to
strengthen response systems. Creating a
trauma coalition provided the vehicle to
maximize system capacity, thereby improv-
ing the mental health and social outcomes
for increasing numbers of Israelis at risk for
posttraumatic stress conditions. Drawing
from the lessons learned from our work in
Israel, the federation system is well posi-
tioned to use its wealth of resources to de-
velop and maintain a comprehensive and
sophisticated model of disaster planning
and emergency response.
ACKNOWLEDGMENTS
UJA-Federation is grateful to Dr. Claude Chem-
tob. Professor of Psychiatry and Pediatrics at Mount
Sinai Medical Center, for serving as advisor and for
ideas that are reflected in the trauma initiatives;
Roberta Leiner, UJA-Federation of NY and Eli-
sheva Flamm-Oren of UJA-Federation's Israel of-
Journal of Jewish Communal Service, Vol. 83, No. 1, Fall 2007
fice for being instrumental in the development and
launching of the Trauma Coahtion; and Dr. Danny
Brom, Tali Levanon, and the members of the Israel
Trauma Coalition for their commitment and dedi-
cation to this endeavor.
REFERENCES
Chemtob, C. M. (2002, May). A public health ap-
proach to disaster recovery and preparedness. Pa-
per presented at the Health Promotion Confer-
ence, New York Academy of Medicine and New
York City Department of Public Health, New
York.
Chemtob, C. M. (2002, June 30). Effective child
trauma treatment: Integrating public health and
clinical approaches. Paper presented at First Bi-
National Child Trauma Treatment Conference,
Jerusalem.
Horwitz, S., & Leiner, R. (2003). Non-traditional
first responders: Roles, challenges and opportu-
nities for Jewish communal professionals re-
sponding to emergencies. Journal of Jewish
Communal Service.