Editor's Note: CIDRAP's Promising Practices: Pandemic Influenza Preparedness Tools online database showcases peer-reviewed practices, including useful tools to help others with their planning. This article is one of a biweekly series exploring the development of these practices. We hope that describing the process and context of these practices enhances pandemic planning.
Dec 17, 2007 (CIDRAP News) – In the wake of Sep 11, 2001, a group of disaster response experts collaborated on a project to incorporate spirituality into emergency response. Their work already has served as a blueprint for helping people in emergencies, including a college campus shooting, and may prove valuable for an influenza pandemic as well.
Media coverage of disasters frequently portrays people struggling with spiritual pain and confusion. Victims may wonder why they were harmed, survivors question why they were spared, and many struggle to cope with loss and change.
The National Voluntary Organizations Active in Disaster (NVOAD) is a Washington, DC–based group of national, state, local, and faith-based volunteer organizations. In the event of a disaster, NVOAD guides the response of member organizations. That collaboration is intended to reduce redundancy in volunteer response, said Kevin Massey. Massey, a board-certified chaplain, is the assistant director for the Evangelical Lutheran Church in America's Domestic Disaster Response group.
NVOAD coordinated teams of volunteers after the Sep 11, 2001, attack in New York City. The focus for most responders was saving lives. Volunteer organizations found their standard mission of reconstruction was ill-suited to the jarring demands of a mass victim response, Massey said. Volunteers shifted their approach and began to offer spiritual care in a comforting environment, where people could discuss emotions and beliefs.
Addressing spiritual needs
In response to members' experiences in providing spiritual care after Sep 11, NVOAD formed an emotional and spiritual care committee in 2001. The committee included people from a variety of affiliate organizations, including Church World Service, United Jewish Communities, and the Association of Professional Chaplains.
Members brought a strong background in early psychological intervention (EPI), Massey said. EPI is a therapeutic approach that entails pre-incident training for mental health professionals, critical incident stress management, psychological first aid, and long-term counseling and therapy.
Committee members identified several priorities for improving disaster response. For example, as part of NVOAD, they had to consider the challenges for volunteers. Volunteers may find their jobs especially difficult when their focus turns from building houses and fulfilling basic needs to aiding the overwhelmed.
Further, the response for brief emergencies may differ from the response to a prolonged disaster such as an influenza pandemic. (Experts suggest an influenza pandemic could last as long as 2 years, including waves of illness affecting communities for 6 to 8 weeks at a time.)
Special care was needed in approaching the nebulous and sensitive topic of spirituality. The committee wanted to clearly state that disasters should never be used as an opportunity for religious proselytism, Massey said.
Handbook for spiritual health
The committee completed a handbook on spiritual health tools in July 2006. The handbook, Light Our Way, guides disaster relief workers as they assist victims and as they themselves recover from difficult response efforts, Massey said.
The committee wrote Light Our Way from an all-hazards perspective, and members specifically tailored their messages to the stages of disaster response. Chapters apply to acute spiritual care, long-term recovery, collaboration with mental and emotional health personnel, self-care for providers, and community resiliency and preparedness training.
The need for spiritual care in a community would be ongoing during and after a disaster, Massey said. A long emergency, such as an influenza pandemic, would require an enduring response.
The idea for the handbook came from "a desire to have a manual of best practices for chaplains doing disaster response," said Massey, who served as the author.The committee wanted the handbook to address principles of spiritual care to which all members could adhere. Light Our Way describes its intended audience as "disaster responders who put their personal plans and routines on hold in the event of a local or national disaster."
The guide describesspiritual care as imperative to an individual's well-being following a disaster or trauma. It defines spiritual care as "anything that nurtures the human spirit as a source of strength in coping with the crisis." Examples include listening to a disaster victim tell his or her story, providing a religious ritual or vigil, offering food and shelter to relief workers, and supplying "spontaneous generosity."
Clergy and other spiritual care providers risk suffering exhaustion as a result of their close relationships with traumatized individuals, Massey said. Spiritual care during a disaster will further require volunteers to be "doing their best work for a potentially long period of time," he added. "Disaster response is a marathon, not a sprint."
This long-term view of disaster may be particularly helpful in an influenza pandemic. Many clergy and nonprofit staff are taxed with a multitude of duties and causes during nondisaster times. Self-care is necessary for clergy and volunteers who wish to help members of their communities through a disaster. Light Our Way encourages responders to monitor their own spiritual health before and during a disaster by doing small amounts of work over a long period of time and recognizing the signs of fatigue.
A trial by fire
Although the handbook was years in the making, it was put to use quickly. Light Our Way was used after a college student opened fire on the Virginia Tech campus on Apr 16, killing 32 people before shooting himself.
Rev. Jim Kirk, associate pastor at Moorings Presbyterian Church in Naples, Fla., and a volunteer for the Presbyterian Disaster Assistance National Response Team, arrived in Blacksburg, Va., on Apr 16. He distributed about 100 copies of Light Our Way to congregations, campus ministers, and other local faith leaders.
He said he recalled thinking, "How in the world do we talk to all these students in various faith communities? How do we help them make sense of what happened?"
Spiritual care was crucial for students returning to campus after the shooting, he said.
"One of the most important things was to have a safe place to ask questions, like 'Why did God let this happen?'" Kirk said. "There was a strong international student dynamic [at Virginia Tech]. Light Our Way stresses listening to someone and trying to understand their beliefs. You need to make sure you're acknowledging and affirming their rituals."
The guide was particularly useful as volunteers realized that self-care was necessary for those who counseled students. In the days following the shooting, "everyone was running on adrenaline, and there was no time to say 'Let's talk about how we’re feeling.' Everyone was in response mode," Kirk noted.
Several volunteers and chaplains suffered from compassion fatigue after their response efforts, he said. Light Our Way was a useful resource in addressing that fatigue, said Kirk, who added: "Spiritual care needs to be ongoing and reinforced with the need for self-care, especially for faith leaders."
View tools and reviewers' comments for the "Light Our Way" practice