Mental Health Response to Mass Violence and Terrorism
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Acknowledgements
This publication was produced under Interagency Agreement #RA00C5400A between the U.S.
Department of Justice (DOJ), Office for Victims of Crime (OVC), and the Center for Mental Health
Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA). DOJ
provided funds for the development of the document; SAMHSA provided funds for the editing,
design, layout, and printing of the publication. The document was written by Deborah J. DeWolfe,
Ph.D., M.S.P.H., and reviewed by a group of experts on mass violence and mental health response.
The SAMHSA Disaster Technical Assistance Center (DTAC), ESI, under contract with CMHS, edited
the document and designed the cover and layout for this publication.
Disclaimer
The content in this publication is solely the responsibility of the author and does not necessarily
represent the position of U.S. DOJ, OVC; SAMHSA or its centers.
Public Domain Notice
All material appearing in this report is in the public domain and may be reproduced or copied
without permission from SAMHSA or CMHS. Citation of the source is appreciated. However, this
publication may not be reproduced or distributed for a fee without the specific, written authorization
of the Office of Communications, SAMHSA, Department of Health and Human Services (DHHS).
Electronic Access and Copies Of Publication
This publication can be accessed electronically through the following Internet connections:
www.samhsa.gov and www.ncjrs.org. For additional free copies of this document, please contact
SAMHSA's National Mental Health Information Center, and ask for Publication No. SMA 3959, at
1-800-789-2647, 1-866-889-2647 (TDD); or contact the OVC Resource Center, and ask for
Publication No. NCJ 205451, at 1-800-851-3420, 1-877-712-9279 (TTY).
Recommended Citation
U.S. Department of Health and Human Services. Mental Health Response to Mass Violence and
Terrorism: A Training Manual. DHHS Pub. No. SMA 3959. Rockville, MD: Center for Mental Health
Services, Substance Abuse and Mental Health Services Administration, 2004.
Originating Office
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road, Rockville, Maryland 20857
DHHS Publication No. SMA 3959
Printed 2004
TABLE OF CONTENTS
Preface
CHAPTER I. Background and Overview
Purpose of the Manual
Overview of the Manual
Overview of Resources
Glossary of Acronyms
CHAPTER II. Human Responses to Mass Violence and
Terrorism
Population Exposure
Model
Traumatic Event
and Stressor Characteristics
Survivor Characteristics
Immediate Adult
Reactions to Trauma, Victimization, and Sudden Bereavement
Long-Term Responses
of Adults
Model of Human
Responses to Trauma and Bereavement
Children and Adolescents:
Priority Considerations and Reactions
Older Adults:
Priority Considerations and Reactions
Cultural and
Ethnic Groups: Priority Considerations and Reactions
Recommended Reading
CHAPTER III. Mental Health Intervention
Key Principles for Mental
Health Intervention
Immediate Mental
Health Intervention
Immediate
Mental Health Interventions with Adults
Long-Term Mental
Health Interventions with Adults
Immediate Mental
Health Interventions for Children and Adolescents
Long-Term Mental
Health Interventions for Children and Adolescents
Considerations
for Immediate and Long-Term Mental Health Intervention With Cultural and Ethnic
Groups
Key Events with Mental
Health Implications
Interventions
with the Community
Recommended Reading
CHAPTER IV. Organizational Preparation and Response to Mass Violence and Terrorism and
the Mental Health Role
Emergency Operations
Crisis Mental Health
Response
Key Considerations for Mental
Health Providers Responding to Criminal Mass Violence
Crisis Mental Health
Response: Future Directions
Long-Term Mental Health
and Crime Victim Assistance Services
Recommended Reading
CHAPTER V. Stress Prevention, Management, and Intervention
Sources of Stress
Stress Prevention, Management,
and Intervention
Compassion Fatigue
and Secondary Traumatization
Signs and Symptoms of
Worker Stress
Rewards and Joys of
Disaster Work
Recommended Reading
CHAPTER VI. Setting Up Training
Rapid Response Training
Comprehensive
Training
Selection of Qualified
Trainers
Setting Up Training
Who Should Attend?
CHAPTER VII. Comprehensive Training Course Outline
Course Overview
Course Objectives
Overview of Comprehensive
Training Course
Module 1: Introduction
Module 2: Criminal Mass
Victimization
Module 3: Adult Responses
to Mass Violence and Terrorism
Module 4: Organizational
Response and Mental Health Roles
Module 5: Community
Crisis Response and Mental Health Interventions
Module 6. Children's
and Adolescents' Reactions and Interventions
Module 7: Cultural and
Ethnic Groups: Considerations and Interventions
Module 8: Planning Workgroups
Module 9: Stress Prevention,
Management, and Intervention
Training Overheads
Handouts
Videotapes
CHAPTER VIII. Additional Training Needs and Options
Training for Paraprofessional
Staff
Training for Human
Service Workers
Topics and Considerations
for In-Service Training
References and Additional Reading
Internet Sites
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