Preparing Social Workers to Respond to Emergencies and Human- Made Disasters: Introducing essential elements of Disaster Mental Health in MSW education

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These disasters impact individuals, families, and whole communities with emergent basic needs such as temporary shelter, food and water, as well as psychological needs such as acute stress, grief and hopelessness (Halpern, Nitza & Vermeulen, 2019). Social workers are called to action as first responders and to aid in the ongoing healing process, yet most do not have pre-event training. This project provided an introduction to disaster mental health (DMH) training in MSW education through the development, implementation and evaluation of a learning module for specialized practice courses with the goal to strengthen the future social workers capacity to respond to disasters. The project was evaluated using an on-line, self-report, post-module survey. This study provides preliminary data and support that an introduction to the key concepts and skills of disaster mental health could be implemented in MSW coursework. The responses also indicated participants’ pedagogical strategy and future course interests with most identifying this content as an appropriate venue for practice courses; an option of an elective in DMH and/or the need for inter-professional education. The results could inform future curriculum decisions and offerings within MSW/ post- MSW education. Disaster response mass shooting disaster mental health social work education Introduction On December 14, 2012, twenty 1st graders and six educators entered Sandy Hook Elementary School and never returned home. As the country mourned the deaths of these souls, many chanted the call “never again.” Despite that plea, Everytown for Gun Safety (2023) asserted that both the number of mass shootings- incidents in which four or more people were shot and killed, not including the shooter- and the number of people shot in them have continued to increase reaching a high of 686 mass shooting incidents in 2021. The United States has had the most mass shootings out of the economically developed nations (Palazzolo & Flynn, 2015). Additionally, throughout the country, we are experiencing multiple disasters: extreme weather events such as hurricanes, tornadoes, and wildfires alongside human-made disasters such as mass shootings and bombings. These disasters impact individuals, families, and whole communities with emergent basic needs such as temporary shelter, food, and water, as well as psychological needs such as acute stress, grief, and hopelessness (Halpern et al., 2019). In the twelve years since the tragic mass shooting at Sandy Hook, there have been hundreds of victims and thousands of families impacted by these human-made disasters. Social workers must be prepared to respond in times of disaster and are often on the front-lines, side-by-side with first responders such as law enforcement and medical personnel, supporting victims. We may be called to action when the communities we live in are impacted, or when nearby community supports are overtaxed. In 2008 and again in 2012, the American Medical Association recommended enhanced disaster mental health (DMH) training for professional and paraprofessionals. For social workers, additional training is needed at the masters’ level to ensure our students are prepared to serve. The primary goal of this project was to contribute towards the readiness of the social work field to respond to disasters, specifically human-made disasters such as mass shootings. To that end, I developed, implemented, and evaluated a learning module for MSW students in the key concepts and skills of DMH. The results could inform future curriculum decisions and offerings within MSW and post-MSW education. Relevance and Importance of the Project The skills, knowledge, and attitudes required for disaster mental health are different from those needed in typical, office-based clinical mental health services (Pfeffenbaum et al., 2012; Streufert, 2004; Werner, 2014). Though mental health professionals are trained in basic skills such as engagement and assessment, DMH is specialized and distinct in order to manage extreme stress, trauma, intensity, and collaboration with other emergency responders. Much of the DMH literature highlights the need for disaster preparedness as a first step in effective disaster response. Preparedness includes training pre-event and can be delivered online or in-person, and ideally includes simulation activities and training events. This project has personal significance for me as I reflect on the response provided by myself and our team following the tragic shooting at Sandy Hook and the preparation and training that was obtained “just in time”- two days after the shooting. Just in time training provides responders with the information they need immediately before they are asked to provide support (IOM,2015). This project introduced DMH as a vital learning area for MSW students in order to enhance their capacity to respond when called to serve. Literature review The United States has more mass shooting events than any other country in the world (Wintemute, 2015). Mass shootings are a particular problem in the United States, with one mass shooting occurring approximately every 12.5 days (Meindi & Ivy, 2017). Still, a 2019 survey by the American Psychological Association indicated that nearly 80% of adults experience stress as a result of the possibility of a mass shooting. Mass shooting events have occurred in schools, universities, churches and synagogues, shopping malls, movie theaters, concerts, and restaurants—settings where people previously felt safe and secure. Shultz et al. (2014) noted that mass shootings often occur in communities with low crime rates and limited exposure to violence, further rattling the citizens’ security. Some of the mental health risks may be mitigated through effective DMH services, post-event, but the quality of services received is key. Murtoen et al. (2012) found that the perception of early support as unhelpful was linked to more severe distress. This suggests that those who do not benefit from DMH interventions may be at risk for ongoing distress, thus providing further evidence of the need for a high-quality response, post-event. It is common for individuals, families, and communities to experience significant distress and grief following a disaster. Some of the symptoms may include sadness, feeling numb, difficulty sleeping, trouble concentrating, and isolation. Physical symptoms can include physiological effects such as headaches, stomachaches, or difficulty breathing. In the short term, there will likely be an increase in grief, depression, anxiety, family conflict and alcohol and substance abuse in adults (North & Pfefferbaum, 2013). Children, the elderly and people living in poverty are more vulnerable to develop lasting symptoms (Halpern & Vermeulen, 2017). Typically, the transient, reactions dissipate, and most people ultimately return to their previous level of functioning (Halpern et al., 2019; Lowe & Galea, 2015; Shultz et al., 2014). Serious psychological impairment continues in only a fraction of those exposed, typically less than 30% (Bonanno et al., 2010). Mass shootings may also redefine our beliefs about the world and safety in our communities. Lowe and Galea (2015) asserted that, “Mass shootings exert a psychological toll on their direct victims and members of the communities in which they took place” (p 17). There are multiple factors to consider when examining the impact of these events on children, adolescents, young adults/college students, and communities, detailed in the following sections. Degree of Exposure Exposure to a disaster, both in intensity and severity, is considered a predictive risk factor for ongoing mental health problems (Shultz et al., 2014). Proximity refers to how an individual experienced an event: whether they were at the location where the disaster occurred; or heard the disaster occur; or were physically close to someone who experienced the disaster. Additionally, perception and fear of death may also predict later psychological reactions and distress (Schwarz & Kowalski, 1991). The research about shootings on college campuses has encouraged the examination of exposure level as well as symptom severity. Hughes et al. (2011) categorized exposure type with various levels of posttraumatic stress: high levels are associated with the loss of a close friend or the uncertainty about the safety of a close friend/loved one; lesser levels are associated with having missed a routinely scheduled class where the shooting took place, having a close friend who escaped unharmed, or even being in close proximity to the event but unharmed. In a college setting, there are likely more frequent visual reminders, such as the loss of friends and memorial events, that create exposure at multiple levels (Liu & Kia-Keating, 2019). This exposure-level knowledge could be relevant in developing future training specific to responding to disaster events at colleges. Impact from Media Coverage The increase in technology and media outlets have created the rapid and frequent dissemination of information about disasters. Unfortunately, much of the disaster coverage uses graphic, visual images, which broaden the impact of the event and may actually fuel a cycle of distress, increased anxiety and confusion (Bonanno et al., 2010; Thompson, et al., 2019). Media coverage of disasters must be executed with care, as press coverage can unintentionally harm those already suffering. Research has shown that news stories can remind survivors of previous disaster events, and their reactions to coverage may be similar to their original reactions (Houston et al., 2018). Media coverage of mass shootings and their aftermath reaches far beyond affected communities. Media exposure, particularly for children, can have a lasting effect, even when the child was not directly exposed to the disaster event (nctsn.org, n.d.). Research has linked media exposure to disaster-related distress, flashbacks, intrusive memories and even prolonged stress-related illnesses (Bonanno et al., 2010; Thompson, et al., 2019). The media will likely also attend public memorials, fundamentally threatening the security and cohesion of communities (Hagman, 2017; Halpern, et al., 2019). This intrusion can create secondary stress for victims’ families and survivors, as the press further amplifies feelings of loss and grief. Communities Mass shootings not only impact their direct victims but also the surrounding community. The association and proximity to victims may be a significant factor to consider in small communities (Shultz et al., 2014), where there will be several connection points to the disaster. Additionally, there can be disruption to community infrastructure, such as the relocation of schools and overtaxed resources and supports. It is also important to note that many disasters elicit an outpouring of mutual aid and assistance during the “compassionate stage” (Bonanno et al., 2010). During this phase, there may be increased solidarity, a sense of unity, reduced community conflict, and celebrations of heroic acts. Resilience can be understood in the context of individuals and/or communities. Community resilience is defined as the sustained ability of communities to withstand, adapt to, and recover from adversity (phe.gov, n.d.) and is considered an important element in disaster recovery. A resilient community has social connectedness and the capacity to withstand a disaster, recover its health and educational systems, and to aid in recovery. Norris et al. (2008) have highlighted the importance of community resilience in disaster recovery to include: economic development, social capital, information and communication, and community competence. Of note, the community’s capacity pre-disaster is relevant. When a disaster occurs in a lower-income neighborhood, there is greater vulnerability for the folks in that neighborhood to rebuild and recover (Committee on Post-Disaster Recovery of a Community, 2015). Disasters often cause disproportionate hardship for vulnerable populations and low-income neighborhoods; thus, recovery planning requires careful attention. One only needs to consider the devastating effects of Hurricane Katrina on the ninth ward in New Orleans to illustrate this issue. Survivors were displaced from their neighborhoods, leaving social networks strained and broken (Osofsky & Osofsky, 2018). While Hurricane Katrina was a natural disaster, there is much to be learned about the impact of disasters on vulnerable populations from the response and recovery efforts in New Orleans. Cultural Considerations The racial and ethnic diversity of the United States population is continuing to increase, requiring a more inclusive approach to disaster response and recovery activities (phe.gov, n.d.). Additionally, disaster responders and victims may differ in their racial, ethnic, and/or language characteristics. Culturally and linguistically diverse populations may be misunderstood and not receive appropriate services as needed. It is imperative that those responding to a disaster consider communication barriers, potential biases (Bethel et al., 2013; Davidson et al., 2013), a mistrust of government and authorities, and concern for family and social networks (Eisenman et al., 2007). By improving the language capacities of responders, and becoming aware of potential biases, social workers can provide a quality response to diverse populations in a culturally sensitive manner. Disaster Mental Health: Training Efforts and Gaps Disaster response is complex and often includes local, state, and federal emergency management entities as well as first responders such as police and firefighters, the Red Cross, clergy, and mental health providers. If the disaster is considered a crime, various levels of law enforcement will be involved and can include the FBI, National Guard, and State and Federal Offices of Victim Services (Halpern et al., 2019). Over the past decade, a growing body of research shows five essential elements of psychological disaster response: safety, calming, sense of self and community efficacy, connectedness, and hope. These essential elements were then translated into recommended policy and practice for dissemination, methods for delivery, and suggested implementation priorities (Benedek & Fullerton, 2007; Hobfoll, 2007). Dissemination includes both stakeholder buy-in as well as training efforts. Benedek & Fullerton (2007) stated, “If these principles are to become the cornerstone of immediate and mid-term interventions, they must be familiar, understood, accepted and embraced by the diverse and heterogenous population- not merely mental health professional and disaster and public health workers” (p.346). Many of these principles have been incorporated into the best-known disaster response program: Psychological First Aid. Of note, simply because disasters by their very nature occur without warning, it has been difficult to conduct research on the effectiveness of disaster mental health interventions (Halpern, et al, 2019). Some of the richest lessons have been reflections on the various case examples that have occurred in the recent past: 9/11, the Boston Bombing, and Sandy Hook, to name a few. Over the past fifteen years, the most widely utilized framework for disaster response is Psychological First Aid; however, it is also important to be aware of the American Red Cross’s response, crisis intervention techniques, and other models of support. Crisis Intervention Crisis intervention skills are core components in responding to mass shootings or community crises. The key components of crisis intervention are the following: basic needs assessment, risk assessment, coping and stress management, and referral to needed services. After the immediate crisis, interventions focused on fostering resilience and recovery are appropriate (Boscarino, 2015; Steele, 2015). It is also important for mental health providers to provide psychoeducation on the typical reactions to an acute event or trauma and link to professional resources when necessary. Determining an ordinary reaction to extraordinary events, versus a response that needs further intervention, is a needed skill of those providing disaster response (Jacobs et al., 2016). Of note, in school settings, crisis preparation and crisis plans often involve the school social worker. These plans are usually exercised and include response to a major school crisis (Werner, 2014). Typically, social workers are trained in the basic skills of crisis intervention. Family Death Notification A death notification is the formal delivery of the news of a death to another person. The notifier is typically a member of law enforcement, medical personnel, clergy, or a mental health provider. A proper death notification allows the receiver to begin the grieving process (Lord, 2008), and a negative experience can add to the trauma of a loved one’s death (Janzen et al., 2004). Certain categories of social workers are well-trained in the notification process, for example, those professionals who work in hospice and end-of life palliative care. Janzen et al. (2004) summarized the core components of interventions needed by social workers for bereaved parents as: normalizing and validating feelings; providing information about grief; problem solving; facilitating the basic needs of parents’ advocacy; and providing referrals. Parents may need time to discuss the details of the death; however, at times, professionals may attempt to “shield” parents from this information. There are often differences between the notifier and survivor, such as a difference in ethnic, socioeconomic, cultural, religious, and family background (Eberwein, 2006; Miller, 2008), requiring cross-cultural training on death notifications. Notifier stress can be significant, especially when the death is of a child, and professional support is essential (Miller, 2008). Training Efforts Since the early 1990s, the American Red Cross has been working to develop a more systematic and organized plan for DMH. The Red Cross coordinates a large volunteer network of cross-discipline mental health providers from fields such as psychology, psychiatry, nursing, social work, marriage and family therapy, and counseling (North et al., 2000; redcross.org). Since 2005, the National Child Traumatic Stress Network and National Center for PTSD have solidified training efforts, including the development of field manuals, train-the-trainer options, and on-site trainings immediately available post-disaster; also known as “just in time” training. Disaster mental health has been utilized for hundreds of natural and man-made tragic events; however, there have been challenges in recruiting sufficient numbers of mental health providers trained in DMH (Jacobs et al., 2016), particularly regarding large scale events. Mental health providers trained in DMH have to be able to respond within hours/days of the event, and perhaps for weeks, to assist in mass disaster events. To more closely match the need, the International Red Cross has advised Community-Based Psychological First Aid (CBPFA) be expanded to include the training of community members to provide basic psychological support for friends, neighbors, co-workers, and even their own family members (Jacobs, 2007). This model can be particularly helpful to communities where traditionally trained mental health providers may not be readily available. Since 2014, the US Department of Health and Human Services (HHS) has recommended PFA training for disaster responders, the all-volunteer Medical Reserve Corp (Jacobs et al., 2016). Social workers, and other mental health providers, have a greater capacity for assessment and crisis intervention; thus, the field of social work should join this work more formally through the offering of training programs. Training Gaps The lack of professionals trained in disaster mental health may have a negative impact on the preparedness to respond. Reifels et al. (2014) highlighted “key barriers to effective disaster response participation includes the lack of familiarity with disaster mental health interventions and dedicated training” (p. 204). Many mental health professionals, including social workers, have a poor understanding of their role in a disaster response team as they are neither part of a pre-existing or post-disaster response team (Math et al., 2015). Furthermore, some of the above training models can be provided to community members. This may be especially helpful to aid communities where there is a dearth of professional mental health providers, allowing for enhanced capacity at a local level. Even when there is a team of volunteers, there is a need for trained mental health providers to provide oversight, care, and support to those responding. It is well known that disaster relief results in a considerable amount of stress; thus, the risk of compassion fatigue and vicarious traumatization are high (Adamson, 2018; Math et al., 2015; Nuttman-Shwartz, 2015). It is essential to monitor the disaster responders’ mental and physical health, and having social workers trained and involved in the response is beneficial for the victims as well as for those community members providing the disaster support. Project and Methodology To further prepare the field of social work, I developed, implemented, and evaluated an introductory learning module that could be used in various MSW courses (i.e., General Practice I/II; crisis intervention or trauma-focused coursework) on the fundamental knowledge and skills needed by social workers to respond to disasters in their community and beyond. The original plan for the learning module included the following: conceptual definitions of DMH, readings, case studies for simulation and role play, and written activities that assess comprehension and skillfulness (e.g., discussion post questions, written assignments, process recordings of role plays). Rubrics for module assessments were also planned to assess the students’ learning. Modifications were necessary due to the shift in academic environments during COVID-19. Research Design The primary goal of this project was to advance the education of MSW students in key concepts and skills of DMH to strengthen the social work profession’s capacity to respond to disasters, specifically human-made disasters such as mass shootings. This project provided an introduction to DMH training in MSW education through the development, implementation, and evaluation of a learning module for specialized practice courses. The primary research questions were: 1. Did the students’ experience of the learning module increase their knowledge and skills in DMH? 2. Did the learning module spark an interest in DMH? 3. How can the MSW curriculum incorporate the topic of DMH? Based on the available literature five learning objectives were constructed for the learning module: · Describe different types of disasters, including natural and human-made disasters, and their impact on individuals and communities. · Explore key elements of disaster mental health including crisis intervention, death notification, education, advocacy, problem solving, and resource support. · Identify risk factors that make certain groups or individuals more vulnerable during and after disasters · Review the principles of Psychological First Aid (PFA) and practice its elements. · Understand the importance of self-care for disaster responders and consider healthy coping mechanisms in preparation for participation in DMH. Pedagogical details: The original learning module included asynchronous pre-class readings of two required and one optional journal articles before each of the two sessions and a total of five hours of on-ground/live class time. Due to COVID-19, the asynchronous pre-class reading was re-designed to include a discussion with an assigned reading group, and the synchronous learning module portion was reduced to a synchronous, online zoom format of 90 minutes per session, or three hours total. The synchronous, online classes consisted of PowerPoint slides, lecture, discussion, small-group break out practice sessions, and reflection. Participants and Procedures Thirty-one (31) MSW 2 nd -year students attended the two-week learning module in the Spring 2021 semester. Twenty students completed the online evaluation as participants in this research project. In early 2020, I met with the Director of Social Work and a full-time faculty member at a private university in New England to present a plan to add DMH into the MSW curriculum. After obtaining the required IRB approvals, I worked closely with the faculty member to finalize the procedural logistics of the implementation of the learning module in four sections of the Spring 2021 specialized practice course co-taught by a faculty member and the Director of the Social Work program. The learning module was then implemented in the Spring semester (in early February 2021). Data Collection This project was evaluated using an online survey to ascertain student experience of the learning module and to inform future curriculum decisions and offerings on the topic of DMH. More specifically, this survey design approach was selected to provide anonymity and accessibility for students to evaluate the learning module and describe their interest in the topic of DMH, the main takeaways, and an interest in future coursework. Data addressing Question 1 (student evaluation of the DMH learning module) was collected with the first three (3) Likert scale questions and three (3) open-ended/free-text questions. Data addressing question 2 (sparking an interest) was collected with the final two (2) Likert scale questions. Data addressing question 3 (future curriculum offerings) was collected with two (2) multiple choice questions. Participants were also asked to provide optional demographic data (race/ethnicity, gender and age). At the end of the learning module, students were provided the link to the survey. Data Analysis All participants completed the Likert-scale questions. The free-text questions had variable levels of completion. The quantitative data were analyzed using descriptive statistics, including frequency, mean, and standard deviation. Qualitative data in the three (3) open-ended questions were analyzed using content analysis (Creswell, & Poth, 2018). Open-ended questions were included in the survey to hear directly from the study participants on main takeaways from the learning module, what remained confusing, and what they would like to know more about. This feedback could not be easily obtained via predetermined questions, and this writer wanted to empower the participants to share their learning and concerns; thus, free text was the chosen format. The responses were then reviewed and re-read several times and then sorted into themes. Results Of the 31 participants in the synchronous learning module, 20 participated in the post-module survey (65%). The majority of participants identified as White/Caucasian, cisgender women between the ages of 20–29. While all study participants self-identified their race/ethnicity, four did not identify their gender and one did not report their age. Three participants identified as Hispanic/Latinx, one as Black/African-American, and one as multi-racial/bi-racial. When reviewing race/ethnicity, no participants identified as Asian/Pacific Islander, Native American/Alaskan Native, or a race/ethnicity not listed. No study participants identified their gender as cisgender man, transgender woman, transgender man, gender non-conforming, or a gender not listed. No study participants identified their age as over 60. Overall, student ratings of their experiences of the learning module were quite high. Overall, the responses indicated that the objectives of the learning module were well explained, and increased the knowledge of the participants on the topic (M = 5). Participants had a slightly lower mean score evaluating their specific skill learning (M = 4.75). The most reported takeaway (41%) focused on learning the practice of Psychological First Aid and its applicability in DMH and across the field when working with trauma survivors. Students wrote: “I am happy to have learned the basics of PFA because even if we do not practice directly in DMH, we may well need those skills”; “The Psychological First Aid model benefits our communities long term due to its ability to support more people”; and “PFA is an empathetic and effective way in such intense and traumatic settings.” Additionally, 65% of participants identified the learning module as a strong foundation/introduction to DMH. Participants noted, “This model was packed with information”; “a great foundation for how to approach a situation like this”; “DMH is a vital part of our profession. It supports our communities in so many ways by incorporating work from each system level”; and on the universality of the learning: “How many different populations of people can use this model. It is universal.” The research question- Did the learning module spark an interest in DMH was completed by all participants. Students expressed a very high degree of interest in knowing more about DMH, with a lower mean and broader range of interest in providing DMH services after graduation (SD .83). Further analysis revealed an observational connection between students who scored lower on the Likert question regarding “sparking an interest” and their qualitative responses regarding the strain of DMH and the need for self-care. One student commented, “I admire and respect what and mental health workers do but I don't currently think I'm in the right head space to do this work. I found this module really informative but really emotional” while another noted the need for “Self-care is also extremely important if working in this (DMH) field.” Research question 3- How can the MSW curriculum incorporate the topic of DMH?- was addressed with two multiple-choice/ “select all that apply” quantitative questions focused on ways instructors can help practice DMH skills and where students would like to have more offerings on the topic of DMH in the social work curriculum. All study participants selected at least one option in the multiple-choice questions.The responses provide an indication of participants’ pedagogical strategy and course interests. Specific to skill development, 90% of the study participants felt internships focused on disaster response could be helpful; 80% selected a deeper dive into case examples from past disasters and role plays; and 60% would want to conduct interviews or hear directly from those that have survived disasters. Specific to offerings in the curricula, 85% of study participants identify practice courses as an appropriate venue for this topic; 75% selected the option of an elective in DMH; and 60% recognize the need for inter-professional education on the topic of DMH. Limitations Certain limitations must be noted. Thirty-one students participated in the learning module and 20 completed the evaluation. The possibility remains that the non-respondents had relevant information to share that could have been quantitatively and/or qualitatively different from respondents. Participants in this student were primarily White, cisgender women, limiting the understanding of how students with other social identifiers would experience this training. The lack of diversity in this study calls for replication with a more diverse group of participants. Discussion Disasters—by their very nature—are unpredictable and cause significant distress and devastation on individuals, families, and whole communities. Much of the DMH literature highlights the need for disaster preparedness as a first step in effective disaster response; and preparedness includes training pre-event . The skills, knowledge, and attitudes required for DMH are different from those needed in typical, office-based clinical mental health services (Pfeffenbaum et al., 2012; Streufert, 2004; Werner, 2014) and require the ability to function in intense situations, manage extreme stress and trauma, and collaborate with other responders. Furthermore, Young et al. (2006) noted that when training takes place in the aftermath of disaster, the content and discussion is shaped by that disaster versus relevant learning objectives; thus, pre-disaster training is optimal. Introductory Knowledge from the Disaster Mental Health Module This learning module sought to address some of the challenges in recruiting sufficient numbers of mental health providers trained in DMH by offering introductory learning within an existing required specialized MSW practice course (Jacobs et al., 2016). This type of DMH introduction to MSW students could more formally prepare future social workers to join DMH work in their own communities and beyond. Even if not formally trained in DMH, social workers have a foundation training in micro and macro roles that are applicable to disaster response. Social workers were trained in the core concepts of PFA to provide “a humane, supportive response to a fellow human being who is suffering and who may need support” (WHO, 2011). PFA includes interventions such as listening, comforting, helping people connect with others, and providing information and practical support to address basic needs (Jacobs et al., 2016; Ruzek et al., 2007). Making explicit connections between social work practice concepts and focused DMH training with MSW students is a natural next step in preparedness. Possible MSW Curricula Offerings Study participants reported strong interest in DMH modules as part of their practice coursework, such as an elective in DMH, the need for inter-disciplinary/inter-professional education, and the need for internships with organizations that provide DMH services. Hokenstad (2007) identified the need for social work education to consider curriculum options that include infusing disaster response into existing courses to expose a larger number of students to DMH as well as a specialization/concentration in the subject. There are a variety of online training opportunities that could serve as pre-disaster training options (Jacobs, et al., 2016; nctsn.org; redcross.org); however, while these opportunities create a volunteer network of mental health professionals, a more intentional training for social work students and professionals is needed. A few schools of social work currently offer DMH in a variety of ways (an undergraduate course, a 1 CEU course, a graduate certificate, an advanced/post-graduate certificate, a dual degree program, and a doctoral specialty track (www.usd.edu; www.du.edu; www.newpaltz.edu; www.sph.tulane.edu). Understandably, there are the multiple requirements for social work education; thus, there is limited room to expand curriculum options (CSWE, 2015). Infusing content within existing courses, elective courses, specializations, and additional certificate programs holds the most promise. It is vital that social work education continues to address the critical issues facing individuals, families, communities, and society at large (CSWE, 2018), such as the growing numbers of disaster events. Additionally, social workers often have the necessary leadership skills needed in disaster response, such as systems thinking, problem solving, relationship building, and team building (CSWE, 2018), further underscoring the need for social work training in DMH and disaster management dual degree options like the one offered at Tulane. Implications for Future Training and Research The purpose of this capstone project was to design, implement, and evaluate a learning module for MSW students in the key concepts and skills of disaster mental health. Ideally, this learning module would be delivered again to allow implementation of the full module content alongside a student assignment with data collection to assess student learning more directly versus a self-report survey. The expanded sections of content could include a deeper dive into factors that impact readiness to respond, the importance of self-care, and more time for skill development and practice sessions. Also, replication of the learning module should occur with a more diverse group of participants to explore the cultural implications for learning and cultural implications for disaster service delivery with more diverse populations. This project has several implications for social work education. Study participants were receptive and expressed a desire to have more DMH content in the curriculum. Future research is needed to test out various curricular designs to determine if there are optimal places in the MSW curriculum for this area of study. Participants identified coursework for additional DMH training—specifically specialized practice and an elective in disaster mental health—for future consideration. Further curricula development could also include a post-graduate CEU option or certificate program. Through the literature review process, it became clear that multiple disciplines participate in disaster response. Young et al. (2007) asserted that DMH offerings could be an academic curriculum component across a variety of disciplines, such as school counseling, psychology, social work, nursing, teaching, and school leadership roles. Interdisciplinary coursework could benefit other fields, further preparing the helpers in our communities to respond to human-made or natural disasters in their communities. The field of DMH is evolving and a relatively young area of practice that expanded in the 1990s with the American Red Cross focus on DMH (Halpern & Vermeulen, 2017) and even more so after 9/11 (Strozier, 2011). Social workers can, and should, plan to play a vital role in this emerging area of practice since we have a micro, mezzo and macro focuses to our work. Social workers could plan a role in pre-disaster preparedness, organizing community training opportunities and developing intervention plans for the most vulnerable groups. Post-disaster, social workers could assist with community coordination, clinical service, and rebuilding efforts (CSWE, 2018). During the expert interviews, it was clear that there is a need for a collaboration across DMH experts on the next steps for this specialty area of practice. There continues to be lack of high-quality research on the effectiveness of DMH interventions as the unpredictable nature of disasters limits the ability of researchers to organize studies on DMH intervention. In the moment of disaster response, the focus is on the response —not on gathering baseline data to then determine the impact of DMH on longer-term recovery (Reifels et al., 2014). This lack of research on the effectiveness of DMH intervention directly impacts the potential research on training of future social workers. Summary The United States is experiencing multiple disasters, ranging from extreme weather events to human-made disasters to an international pandemic. These disasters impact individuals, families, and whole communities with emergent basic needs such as temporary shelter, food, and water, as well as psychological needs such as acute stress, grief, and hopelessness (Halpern et al., 2019). The goal of this project was to develop, implement, and evaluate a disaster mental health learning module for MSW students with the purpose of advancing the preparation of the field to respond to disasters in their communities and beyond. This study provides preliminary data and support that an introduction to the key concepts and skills of DMH could be implemented in a variety of MSW coursework. This learning module requires further opportunity to present the full five-hour module and evaluation with direct student learning measure. When and if successful, the learning module can be disseminated to other MSW programs, thereby further preparing those entering the social work field to respond to disasters, human-made or natural, in their communities. Statements and Declarations The author has no relevant financial or non-financial interests to disclose. The author did not receive support from any organization for the submitted work. Approval was obtained from the IRB committee of Southern CT State University (SCSU). Informed consent to participate in the study was obtained. There are no competing interested to disclose that could bias the research. Datasets supporting the conclusions are available via SCSU capstone archive. No individual data or imagery was utilized thus consent to publish was not required. Acknowledgments: This journey started on December 14, 2012—the day of the mass shooting at Sandy Hook Elementary School in Newtown, CT. On that day, twenty 1 st graders, six educators, and a mother were killed. I honor the lives forever changed by that horrific day, especially those of the Sandy Hook families and staff. By that evening, I was part of a team of committed mental health professionals whom had gathered at the Sandy Hook firehouse to aid in disaster response efforts. This project grew from service to that community, and I am grateful for the national and state experts who served as lifelines and guides along the way. References Adamson, C. (2018). Trauma-Informed supervision in the disaster context. The Clinical Supervisor , 37 (1), 221-240. American Red Cross. (2012). Disaster mental health handbook. Retrieved from: https://www2.cuny.edu/wp-content/uploads/sites/4/page assets/about/administration/offices/ovsa/disaster-relief/hurricanes-harvey-irma/Disaster-Mental-Health-Handbook.pdf American Psychological Association. (2019, August 15). One-third of US adults say fear of mass shootings prevents them from going to certain places or events. 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Routledge Publishing, New York. Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., et al. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry , 70, 283–315. Houston, J.B., First, J. & Danforth, L.M. (2019). Student coping with the effects of disaster media coverage: A qualitative study of school staff perceptions. School Mental Health , 11, 522–53. IOM (Institute of Medicine). 2015. Healthy, resilient, and sustainable communities after disasters: Strategies, opportunities, and planning for recovery. Washington, DC: The National Academies Press. Jacobs, G. (2007). The development and maturation of humanitarian psychology. American Psychologist , 62, 929-941. Jacobs, G., Gray, B., Erickson S., Gonzalez, E. & Quevillon, R. (2016). Disaster mental health and community-based psychological first aid: Concepts and education/training. Journal of Clinical Psychology , 72(12), 1307–1317. Janzen, L., Cadell, S. & Westhues, A. (2004). From death notification through the funeral: Bereaved parents’ experiences and their advice for professionals. Omega , 48(2), 149-164. Liu, S. & Kia-Keating, M. (2019). Novel examination of exposure patterns and posttraumatic stress after a university mass murder. Psychological Trauma: Theory, Research, Practice, and Policy , 11(2), 176–183. Lord, Janice Harris. (2008). I'll never forget those words: a practical guide for death notification. Burnsville, NC: Compassion Books. ISBN 9781878321336 Lowe, S. and Galea, S. (2015). The mental health consequences of mass shootings. Trauma, Violence and Abuse, 18(1), 62-82 Math, S. B., Nirmala, M. C., Moirangthem, S., & Kumar, N. C. (2015). Disaster management: Mental health perspective. Indian journal of psychological medicine , 37(3), 261–271. Meindl, J. & Ivy, J.W. (2017). Mass shootings: The role of the media in promoting generalized imitation. American Journal of Public Health . 107(3),368–370. Miller, L. (2008). Death notification for families of homicide victims: Healing dimensions of a complex process. Omega , 57(4), 367-380. National Child Traumatic Stress Network. PFA and SPR. Retrieved from: https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-for-psychological-recovery North, C.S., Weaver, J.D., Dingman, R.L. et al. (2000). The American Red Cross Disaster mental health services: Development of a cooperative, single function, multidisciplinary service model. The Journal of Behavioral Health Services & Research , 27, 314–320. North, C. & Pfefferbaum, B. (2013). Mental health response to community disasters- A systematic review. The Journal of American Medical Association, 310 (5), 507-518. doi:10.1001/jama.2013.107799 Norris, F. H., Stevens, S. P., Pfefferbaum, B., Wyche, K. F., & Pfefferbaum, R. L. (2008). Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. American Journal of Community Psychology , 41(1–2), 127–150. Nuttman-Shwartz, O. (2015). Shared resilience in traumatic reality: A new concept for trauma workers exposed personally and professionally to collective disaster. Trauma Violence & Abuse , 16(4), 466-475. Osofsky, J. & Osofsky, H.J. (2018). Challenges in building child and family resilience centers after disasters. Journal of Family Social Work , 21(2), 115-128. Palazzolo, J. & Flynn, A. (2015). U.S. leads world in mass shootings. The Wall Street Journal, 10.3.2015. https://www.wsj.com/articles/u-s-leads-world-in-mass-shootings-1443905359 Pfefferbaum, B., Flynn, B. Schonfeld, D., Brown, L., Jacobs, G., Dodgen, D……..Lindley, D. (2012). The integration of mental and behavioral health into disaster preparedness, response and recovery. Disaster Medicine and Public Health Preparedness , 6(1), 60-66. Reifels, L., Naccarella, L., Blashki, G. & Pirkis, J. (2014). Examining disaster mental health workforce capacity. Psychiatry , 72(2), 199-205. Ruzek, J., Brymer, M., Jacob, A., Layne, C., Vernberg, E. & Watson, P. (2007). Psychological First Aid. Journal of Mental Health Counseling , 29(1), 17-49. Schwarz, E.D & Kowalksi, J.M. (1991). Malignant memories: PTSD in children and adults after a school shooting. Journal of the American Academy of Child and Adolescent Psychiatry , 30, 936-944. Shultz, J., Thoresen, S., Flynn, B., Muschert, G., Shaw, J., Espinel, Z., Walter, F., Gaither, J., Garcia-Barcena, Y., O’Keefe, K. & Cohen, A. (2014). Multiple Vantage Points on the Mental Health Effects of Mass Shootings. Current Psychiatry Report , 14, 469. State University of New York (SUNY) New Paltz. Trauma and disaster mental health. Retrieved from: https://www.newpaltz.edu/idmh/academic-programs/grad.html Steele, W. (2015). Trauma in schools and communities: Recovery lessons from survivors and responders. Routledge, New York, New York. Streufert, B. (2004). Death on Campuses: Common postvention strategies in higher education. Death Studies , 28, 151-172. Strozier, C. (2011) Until the fires stopped burning: 9/11 and New York in the words and experiences of survivors and witnesses. New York: Columbia University Press. Thompson, R., Jones, Holman, E., Silver, R. (2019). Media exposure to mass violence events can fuel a cycle of distress. Science Journals , 5, 3502. U.S. Department of Health and Human Services. (2015). Community Resilience. Retrieved from: https://www.phe.gov/Preparedness/planning/abc/Pages/community-resilience.aspx Werner, D. (2014) Are school social workers prepared for a major school crisis? Indicators of individual and school environment preparedness. Children and Schools , 37(1), 28-35. Wintemute, G. (2015). The epidemiology of firearm violence in the twenty-first century United States. Annual Review Public Health , 36, 5–19. Young, B., Ford, J., Ruzek, J., Freidman, M. & Gusman, F. (n.d.) Disaster mental health services-A guidebook for clinicians and administrators. National Center for PTSD. Young, B., Ruzek, J., Wong, M., Salzar, M. & Naturale, A. (2007). Disaster mental health training: guidelines, considerations, and recommendations in interventions following mass violence and disasters—Strategies for mental health practice. Guilford Press. Additional Declarations No competing interests reported. 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As the country mourned the deaths of these souls, many chanted the call \u0026ldquo;never again.\u0026rdquo; \u0026nbsp;Despite that plea, Everytown for Gun Safety (2023) asserted that both the number of mass shootings- incidents in which four or more people were shot and killed, not including the shooter- and the number of people shot in them have continued to increase reaching a high of 686 mass shooting incidents in 2021. The United States has had the most mass shootings out of the economically developed nations (Palazzolo \u0026amp; Flynn, 2015). Additionally, throughout the country, we are experiencing multiple disasters: extreme weather events such as hurricanes, tornadoes, and wildfires alongside human-made disasters such as mass shootings and bombings. These disasters impact individuals, families, and whole communities with emergent basic needs such as temporary shelter, food, and water, as well as psychological needs such as acute stress, grief, and hopelessness (Halpern et al., 2019).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the twelve years since the tragic mass shooting at Sandy Hook, there have been hundreds of victims and thousands of families impacted by these human-made disasters. Social workers must be prepared to respond in times of disaster and are often on the front-lines, side-by-side with first responders such as law enforcement and medical personnel, supporting victims. We may be called to action when the communities we live in are impacted, or when nearby community supports are overtaxed. In 2008 and again in 2012, the American Medical Association recommended enhanced disaster mental health (DMH) training for professional and paraprofessionals. For social workers, additional training is needed at the masters\u0026rsquo; level to ensure our students are prepared to serve. The primary goal of this project was to contribute towards the readiness of the social work field to respond to disasters, specifically human-made disasters such as mass shootings. To that end, I developed, implemented, and evaluated a learning module for MSW students in the key concepts and skills of DMH. The results could inform future curriculum decisions and offerings within MSW and post-MSW education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRelevance and Importance of the Project\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe skills, knowledge, and attitudes required for disaster mental health are different from those needed in typical, office-based clinical mental health services (Pfeffenbaum et al., 2012; Streufert, 2004; Werner, 2014). Though mental health professionals are trained in basic skills such as engagement and assessment, DMH is specialized and distinct in order to manage extreme stress, trauma, intensity, and collaboration with other emergency responders. Much of the DMH literature highlights the need for disaster preparedness as a first step in effective disaster response. Preparedness includes training \u003cem\u003epre-event\u003c/em\u003e and can be delivered online or in-person, and ideally includes simulation activities and training events. This project has personal significance for me as I reflect on the response provided by myself and our team following the tragic shooting at Sandy Hook and the preparation and training that was obtained \u0026ldquo;just in time\u0026rdquo;- two days after the shooting. Just in time training provides responders with the information they need immediately before they are asked to provide support (IOM,2015). \u0026nbsp; This project introduced DMH as a vital learning area for MSW students in order to enhance their capacity to respond when called to serve. \u0026nbsp;\u003c/p\u003e"},{"header":"Literature review","content":"\u003cp\u003eThe United States has more mass shooting events than any other country in the world (Wintemute, 2015). Mass shootings are a particular problem in the United States, with one mass shooting occurring approximately every 12.5 days (Meindi \u0026amp; Ivy, 2017). Still, a 2019 survey by the American Psychological Association indicated that nearly 80% of adults experience stress as a result of the possibility of a mass shooting. Mass shooting events have occurred in schools, universities, churches and synagogues, shopping malls, movie theaters, concerts, and restaurants\u0026mdash;settings where people previously felt safe and secure. \u0026nbsp;Shultz et al. (2014) noted that mass shootings often occur in communities with low crime rates and limited exposure to violence, further rattling the citizens\u0026rsquo; security. Some of the mental health risks may be mitigated through effective DMH services, post-event, but the quality of services received is key. Murtoen et al. (2012) found that the perception of early support as unhelpful was linked to more severe distress. This suggests that those who do not benefit from DMH interventions may be at risk for ongoing distress, thus providing further evidence of the need for a high-quality response, post-event. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt is common for individuals, families, and communities to experience significant distress and grief following a disaster. Some of the symptoms may include sadness, feeling numb, difficulty sleeping, trouble concentrating, and isolation. Physical symptoms can include physiological effects such as headaches, stomachaches, or difficulty breathing. In the short term, there will likely be an increase in grief, depression, anxiety, family conflict and alcohol and substance abuse in adults (North \u0026amp; Pfefferbaum, 2013). Children, the elderly and people living in poverty are more vulnerable to develop lasting symptoms (Halpern \u0026amp; Vermeulen, 2017). Typically, the transient, reactions dissipate, and most people ultimately return to their previous level of functioning (Halpern et al., 2019; Lowe \u0026amp; Galea, 2015; Shultz et al., 2014). Serious psychological impairment continues in only a fraction of those exposed, typically less than 30% (Bonanno et al., 2010). Mass shootings may also redefine our beliefs about the world and safety in our communities. Lowe and Galea (2015) asserted that, \u0026ldquo;Mass shootings exert a psychological toll on their direct victims and members of the communities in which they took place\u0026rdquo; (p 17). There are multiple factors to consider when examining the impact of these events on children, adolescents, young adults/college students, and communities, detailed in the following sections. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDegree of Exposure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExposure to a disaster, both in intensity and severity, is considered a predictive risk factor for ongoing mental health problems (Shultz et al., 2014). Proximity refers to how an individual experienced an event: whether they were at the location where the disaster occurred; or heard the disaster occur; or were physically close to someone who experienced the disaster. Additionally, perception and fear of death may also predict later psychological reactions and distress (Schwarz \u0026amp; Kowalski, 1991). The research about shootings on college campuses has encouraged the examination of exposure level as well as symptom severity. Hughes et al. (2011) categorized exposure type with various levels of posttraumatic stress: \u0026nbsp;high levels are associated with the loss of a close friend or the uncertainty about the safety of a close friend/loved one; lesser levels are associated with having missed a routinely scheduled class where the shooting took place, having a close friend who escaped unharmed, or even being in close proximity to the event but unharmed. In a college setting, there are likely more frequent visual reminders, such as the loss of friends and memorial events, that create exposure at multiple levels (Liu \u0026amp; Kia-Keating, 2019). This exposure-level knowledge could be relevant in developing future training specific to responding to disaster events at colleges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact from Media Coverage\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe increase in technology and media outlets have created the rapid and frequent dissemination of information about disasters. Unfortunately, much of the disaster coverage uses graphic, visual images, which broaden the impact of the event and may actually fuel a cycle of distress, increased anxiety and confusion (Bonanno et al., 2010; Thompson, et al., 2019). Media coverage of disasters must be executed with care, as press coverage can unintentionally harm those already suffering. Research has shown that news stories can remind survivors of previous disaster events, and their reactions to coverage may be similar to their original reactions (Houston et al., 2018). Media coverage of mass shootings and their aftermath reaches far beyond affected communities. Media exposure, particularly for children, can have a lasting effect, even when the child was not directly exposed to the disaster event (nctsn.org, n.d.). Research has linked media exposure to disaster-related distress, flashbacks, intrusive memories and even prolonged stress-related illnesses (Bonanno et al., 2010; Thompson, et al., 2019). \u0026nbsp;The media will likely also attend public memorials, fundamentally threatening the security and cohesion of communities (Hagman, 2017; Halpern, et al., 2019). This intrusion can create secondary stress for victims\u0026rsquo; families and survivors, as the press further amplifies feelings of loss and grief.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMass shootings not only impact their direct victims but also the surrounding community. The association and proximity to victims may be a significant factor to consider in small communities (Shultz et al., 2014), where there will be several connection points to the disaster. Additionally, there can be disruption to community infrastructure, such as the relocation of schools and overtaxed resources and supports. It is also important to note that many disasters elicit an outpouring of mutual aid and assistance during the \u0026ldquo;compassionate stage\u0026rdquo; (Bonanno et al., 2010). During this phase, there may be increased solidarity, a sense of unity, reduced community conflict, and celebrations of heroic acts. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResilience can be understood in the context of individuals and/or communities. Community resilience is defined as the sustained ability of communities to withstand, adapt to, and recover from adversity (phe.gov, n.d.) and is considered an important element in disaster recovery. A resilient community has social connectedness and the capacity to withstand a disaster, recover its health and educational systems, and to aid in recovery. Norris et al. (2008) have highlighted the importance of community resilience in disaster recovery to include: economic development, social capital, information and communication, and community competence. Of note, the community\u0026rsquo;s capacity pre-disaster is relevant. When a disaster occurs in a lower-income neighborhood, there is greater vulnerability for the folks in that neighborhood to rebuild and recover (Committee on Post-Disaster Recovery of a Community, 2015). Disasters often cause disproportionate hardship for vulnerable populations and low-income neighborhoods; thus, recovery planning requires careful attention. One only needs to consider the devastating effects of Hurricane Katrina on the ninth ward in New Orleans to illustrate this issue. \u0026nbsp;Survivors were displaced from their neighborhoods, leaving social networks strained and broken (Osofsky \u0026amp; Osofsky, 2018). While Hurricane Katrina was a natural disaster, there is much to be learned about the impact of disasters on vulnerable populations from the response and recovery efforts in New Orleans. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCultural Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe racial and ethnic diversity of the United States population is continuing to increase, requiring a more inclusive approach to disaster response and recovery activities (phe.gov, n.d.). Additionally, disaster responders and victims may differ in their racial, ethnic, and/or language characteristics. Culturally and linguistically diverse populations may be misunderstood and not receive appropriate services as needed. It is imperative that those responding to a disaster consider communication barriers, potential biases (Bethel et al., 2013; Davidson et al., 2013), a mistrust of government and authorities, and concern for family and social networks (Eisenman et al., 2007). By improving the language capacities of responders, and becoming aware of potential biases, social workers can provide a quality response to diverse populations in a culturally sensitive manner.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisaster Mental Health: Training Efforts and Gaps\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDisaster response is complex and often includes local, state, and federal emergency management entities as well as first responders such as police and firefighters, the Red Cross, clergy, and mental health providers. If the disaster is considered a crime, various levels of law enforcement will be involved and can include the FBI, National Guard, and State and Federal Offices of Victim Services (Halpern et al., 2019). Over the past decade, a growing body of research shows five essential elements of psychological disaster response: \u0026nbsp;safety, calming, sense of self and community efficacy, connectedness, and hope. These essential elements were then translated into recommended policy and practice for dissemination, methods for delivery, and suggested implementation priorities (Benedek \u0026amp; Fullerton, 2007; Hobfoll, 2007). Dissemination includes both stakeholder buy-in as well as training efforts. Benedek \u0026amp; Fullerton (2007) stated, \u0026ldquo;If these principles are to become the cornerstone of immediate and mid-term interventions, they must be familiar, understood, accepted and embraced by the diverse and heterogenous population- not merely mental health professional and disaster and public health workers\u0026rdquo; (p.346). Many of these principles have been incorporated into the best-known disaster response program: Psychological First Aid. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf note, simply because disasters by their very nature occur without warning, it has been difficult to conduct research on the effectiveness of disaster mental health interventions (Halpern, et al, 2019). Some of the richest lessons have been reflections on the various case examples that have occurred in the recent past: 9/11, the Boston Bombing, and Sandy Hook, to name a few. Over the past fifteen years, the most widely utilized framework for disaster response is Psychological First Aid; however, it is also important to be aware of the American Red Cross\u0026rsquo;s response, crisis intervention techniques, and other models of support. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCrisis Intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCrisis intervention skills are core components in responding to mass shootings or community crises. The key components of crisis intervention are the following: basic needs assessment, risk assessment, coping and stress management, and referral to needed services. After the immediate crisis, interventions focused on fostering resilience and recovery are appropriate (Boscarino, 2015; Steele, 2015). \u0026nbsp;It is also important for mental health providers to provide psychoeducation on the typical reactions to an acute event or trauma and link to professional resources when necessary. Determining an ordinary reaction to extraordinary events, versus a response that needs further intervention, is a needed skill of those providing disaster response (Jacobs et al., 2016). Of note, in school settings, crisis preparation and crisis plans often involve the school social worker. These plans are usually exercised and include response to a major school crisis (Werner, 2014). \u0026nbsp;Typically, social workers are trained in the basic skills of crisis intervention. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFamily Death Notification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA death notification is the formal delivery of the news of a death to another person. The notifier is typically a member of law enforcement, medical personnel, clergy, or a mental health provider. A proper death notification allows the receiver to begin the grieving process (Lord, 2008), and a negative experience can add to the trauma of a loved one\u0026rsquo;s death (Janzen et al., 2004). Certain categories of social workers are well-trained in the notification process, for example, those professionals who work in hospice and end-of life palliative care. Janzen et al. (2004) summarized the core components of interventions needed by social workers for bereaved parents as: normalizing and validating feelings; providing information about grief; problem solving; facilitating the basic needs of parents\u0026rsquo; advocacy; and providing referrals. \u0026nbsp;Parents may need time to discuss the details of the death; however, at times, professionals may attempt to \u0026ldquo;shield\u0026rdquo; parents from this information. There are often differences between the notifier and survivor, such as a difference in ethnic, socioeconomic, cultural, religious, and family background (Eberwein, 2006; Miller, 2008), requiring cross-cultural training on death notifications. \u0026nbsp; Notifier stress can be significant, especially when the death is of a child, and professional support is essential (Miller, 2008).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraining Efforts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSince the early 1990s, the American Red Cross has been working to develop a more systematic and organized plan for DMH. The Red Cross coordinates a large volunteer network of cross-discipline mental health providers from fields such as psychology, psychiatry, nursing, social work, marriage and family therapy, and counseling (North et al., 2000; redcross.org). Since 2005, the National Child Traumatic Stress Network and National Center for PTSD have solidified training efforts, including the development of field manuals, train-the-trainer options, and on-site trainings immediately available post-disaster; also known as \u0026ldquo;just in time\u0026rdquo; training. Disaster mental health has been utilized for hundreds of natural and man-made tragic events; however, there have been challenges in recruiting sufficient numbers of mental health providers trained in DMH (Jacobs et al., 2016), particularly regarding large scale events. Mental health providers trained in DMH have to be able to respond \u003cem\u003ewithin\u0026nbsp;\u003c/em\u003ehours/days of the event, and perhaps for weeks, to assist in mass disaster events. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo more closely match the need, the International Red Cross has advised Community-Based Psychological First Aid (CBPFA) be expanded to include the training of community members to provide basic psychological support for friends, neighbors, co-workers, and even their own family members (Jacobs, 2007). This model can be particularly helpful to communities where traditionally trained mental health providers may not be readily available. Since 2014, the US Department of Health and Human Services (HHS) has recommended PFA training for disaster responders, the all-volunteer Medical Reserve Corp (Jacobs et al., 2016). Social workers, and other mental health providers, have a greater capacity for assessment and crisis intervention; thus, the field of social work should join this work more formally through the offering of training programs. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTraining Gaps\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe lack of professionals trained in disaster mental health may have a negative impact on the preparedness to respond. Reifels et al. (2014) highlighted \u0026ldquo;key barriers to effective disaster response participation includes the lack of familiarity with disaster mental health interventions and dedicated training\u0026rdquo; (p. 204). Many mental health professionals, including social workers, have a poor understanding of their role in a disaster response team as they are neither part of a pre-existing or post-disaster response team (Math et al., 2015). Furthermore, some of the above training models can be provided to community members. This may be especially helpful to aid communities where there is a dearth of professional mental health providers, allowing for enhanced capacity at a local level. Even when there is a team of volunteers, there is a need for trained mental health providers to provide oversight, care, and support to those responding. It is well known that disaster relief results in a considerable amount of stress; thus, the risk of compassion fatigue and vicarious traumatization are high (Adamson, 2018; Math et al., 2015; Nuttman-Shwartz, 2015). It is essential to monitor the disaster responders\u0026rsquo; mental and physical health, and having social workers trained and involved in the response is beneficial for the victims as well as for those community members providing the disaster support. \u0026nbsp;\u003c/p\u003e"},{"header":"Project and Methodology ","content":"\u003cp\u003eTo further prepare the field of social work, I developed, implemented, and evaluated an introductory learning module that could be used in various MSW courses (i.e., General Practice I/II; crisis intervention or trauma-focused coursework) on the fundamental knowledge and skills needed by social workers to respond to disasters in their community and beyond. \u0026nbsp;The original plan for the learning module included the following: conceptual definitions of DMH, readings, case studies for simulation and role play, and written activities that assess comprehension and skillfulness (e.g., discussion post questions, written assignments, process recordings of role plays). Rubrics for module assessments were also planned to assess the students’ learning. Modifications were necessary due to the shift in academic environments during COVID-19.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary goal of this project was to advance the education of MSW students in key concepts and skills of DMH to strengthen the social work profession’s capacity to respond to disasters, specifically human-made disasters such as mass shootings. \u0026nbsp; This project provided an introduction to DMH training in MSW education through the development, implementation, and evaluation of a learning module for specialized practice courses. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary research questions were: \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp; \u0026nbsp;Did the students’ experience of the learning module increase their knowledge and skills in DMH?\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp;Did the learning module spark an interest in DMH?\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp;How can the MSW curriculum incorporate the topic of DMH?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the available literature five learning objectives were constructed for the learning module: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e· Describe different types of disasters, including natural and human-made disasters, and their impact on individuals and communities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e· Explore key elements of disaster mental health including crisis intervention, death notification, education, advocacy, problem solving, and resource support.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e· Identify risk factors that make certain groups or individuals more vulnerable during and after disasters\u003c/p\u003e\n\u003cp\u003e· Review the principles of Psychological First Aid (PFA) and practice its elements.\u003c/p\u003e\n\u003cp\u003e· Understand the importance of self-care for disaster responders and consider healthy coping mechanisms in preparation for participation in DMH. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePedagogical details:\u0026nbsp;\u003c/strong\u003eThe original learning module included asynchronous pre-class readings of two required and one optional journal articles before each of the two sessions and a total of five hours of on-ground/live class time. \u0026nbsp;Due to COVID-19, the asynchronous pre-class reading was re-designed to include a discussion with an assigned reading group, and the synchronous learning module portion was reduced to a synchronous, online zoom format of 90 minutes per session, or three hours total. \u0026nbsp;The synchronous, online classes consisted of PowerPoint slides, lecture, discussion, small-group break out practice sessions, and reflection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThirty-one (31) MSW 2\u003csup\u003end\u003c/sup\u003e-year students attended the two-week learning module in the Spring 2021 semester. Twenty students completed the online evaluation as participants in this research project. In early 2020, I met with the Director of Social Work and a full-time faculty member at a private university in New England to present a plan to add DMH into the MSW curriculum. After obtaining the required IRB approvals, I worked closely with the faculty member to finalize the procedural logistics of the implementation of the learning module in four sections of the Spring 2021 specialized practice course co-taught by a faculty member and the Director of the Social Work program. The learning module was then implemented in the Spring semester (in early February 2021). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was evaluated using an online survey to ascertain student experience of the learning module and to inform future curriculum decisions and offerings on the topic of DMH. More specifically, this survey design approach was selected to provide anonymity and accessibility for students to evaluate the learning module and describe their interest in the topic of DMH, the main takeaways, and an interest in future coursework. Data addressing Question 1 (student evaluation of the DMH learning module) was collected with the first three (3) Likert scale questions and three (3) open-ended/free-text questions. Data addressing question 2 (sparking an interest) was collected with the final two (2) Likert scale questions. Data addressing question 3 (future curriculum offerings) was collected with two (2) multiple choice questions. Participants were also asked to provide optional demographic data (race/ethnicity, gender and age). At the end of the learning module, students were provided the link to the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants completed the Likert-scale questions. The free-text questions had variable levels of completion. The quantitative data were analyzed using descriptive statistics, including frequency, mean, and standard deviation. Qualitative data in the three (3) open-ended questions were analyzed using content analysis (Creswell, \u0026amp; Poth, 2018). \u0026nbsp; Open-ended questions were included in the survey to hear directly from the study participants on main takeaways from the learning module, what remained confusing, and what they would like to know more about. \u0026nbsp;This feedback could not be easily obtained via predetermined questions, and this writer wanted to empower the participants to share their learning and concerns; thus, free text was the chosen format. The responses were then reviewed and re-read several times and then sorted into themes. \u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 31 participants in the synchronous learning module, 20 participated in the post-module survey (65%). The majority of participants identified as White/Caucasian, cisgender women between the ages of 20\u0026ndash;29. While all study participants self-identified their race/ethnicity, four did not identify their gender and one did not report their age. Three participants identified as Hispanic/Latinx, one as Black/African-American, and one as multi-racial/bi-racial. When reviewing race/ethnicity, no participants identified as Asian/Pacific Islander, Native American/Alaskan Native, or a race/ethnicity not listed. No study participants identified their gender as cisgender man, transgender woman, transgender man, gender non-conforming, or a gender not listed. No study participants identified their age as over 60.\u003c/p\u003e\u003cp\u003eOverall, student ratings of their experiences of the learning module were quite high. Overall, the responses indicated that the objectives of the learning module were well explained, and increased the knowledge of the participants on the topic (M\u0026thinsp;=\u0026thinsp;5). Participants had a slightly lower mean score evaluating their specific skill learning (M\u0026thinsp;=\u0026thinsp;4.75). The most reported takeaway (41%) focused on learning the practice of Psychological First Aid and its applicability in DMH and across the field when working with trauma survivors. Students wrote: \u0026ldquo;I am happy to have learned the basics of PFA because even if we do not practice directly in DMH, we may well need those skills\u0026rdquo;; \u0026ldquo;The Psychological First Aid model benefits our communities long term due to its ability to support more people\u0026rdquo;; and \u0026ldquo;PFA is an empathetic and effective way in such intense and traumatic settings.\u0026rdquo; Additionally, 65% of participants identified the learning module as a strong foundation/introduction to DMH. Participants noted, \u0026ldquo;This model was packed with information\u0026rdquo;; \u0026ldquo;a great foundation for how to approach a situation like this\u0026rdquo;; \u0026ldquo;DMH is a vital part of our profession. It supports our communities in so many ways by incorporating work from each system level\u0026rdquo;; and on the universality of the learning: \u0026ldquo;How many different populations of people can use this model. It is universal.\u0026rdquo;\u003c/p\u003e\u003cp\u003eThe research question- Did the learning module spark an interest in DMH was completed by all participants. Students expressed a very high degree of interest in knowing more about DMH, with a lower mean and broader range of interest in providing DMH services after graduation (SD .83). Further analysis revealed an observational connection between students who scored lower on the Likert question regarding \u0026ldquo;sparking an interest\u0026rdquo; and their qualitative responses regarding the strain of DMH and the need for self-care. One student commented, \u0026ldquo;I admire and respect what and mental health workers do but I don't currently think I'm in the right head space to do this work. I found this module really informative but really emotional\u0026rdquo; while another noted the need for \u0026ldquo;Self-care is also extremely important if working in this (DMH) field.\u0026rdquo;\u003c/p\u003e\u003cp\u003eResearch question 3- How can the MSW curriculum incorporate the topic of DMH?- was addressed with two multiple-choice/ \u0026ldquo;select all that apply\u0026rdquo; quantitative questions focused on ways instructors can help practice DMH skills and where students would like to have more offerings on the topic of DMH in the social work curriculum. All study participants selected at least one option in the multiple-choice questions.The responses provide an indication of participants\u0026rsquo; pedagogical strategy and course interests. Specific to skill development, 90% of the study participants felt internships focused on disaster response could be helpful; 80% selected a deeper dive into case examples from past disasters and role plays; and 60% would want to conduct interviews or hear directly from those that have survived disasters. Specific to offerings in the curricula, 85% of study participants identify practice courses as an appropriate venue for this topic; 75% selected the option of an elective in DMH; and 60% recognize the need for inter-professional education on the topic of DMH.\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eCertain limitations must be noted. Thirty-one students participated in the learning module and 20 completed the evaluation. The possibility remains that the non-respondents had relevant information to share that could have been quantitatively and/or qualitatively different from respondents. Participants in this student were primarily White, cisgender women, limiting the understanding of how students with other social identifiers would experience this training. The lack of diversity in this study calls for replication with a more diverse group of participants.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDisasters\u0026mdash;by their very nature\u0026mdash;are unpredictable and cause significant distress and devastation on individuals, families, and whole communities. Much of the DMH literature highlights the need for disaster preparedness as a first step in effective disaster response; and preparedness includes training \u003cem\u003epre-event\u003c/em\u003e. The skills, knowledge, and attitudes required for DMH are different from those needed in typical, office-based clinical mental health services (Pfeffenbaum et al., 2012; Streufert, 2004; Werner, 2014) and require the ability to function in intense situations, manage extreme stress and trauma, and collaborate with other responders. Furthermore, Young et al. (2006) noted that when training takes place in the aftermath of disaster, the content and discussion is shaped by \u003cem\u003ethat disaster\u003c/em\u003e versus relevant learning objectives; thus, pre-disaster training is optimal. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntroductory Knowledge from the Disaster Mental Health Module\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis learning module sought to address some of the challenges in recruiting sufficient numbers of mental health providers trained in DMH by offering introductory learning within an existing required specialized MSW practice course (Jacobs et al., 2016). This type of DMH introduction to MSW students could more formally prepare future social workers to join DMH work in their own communities and beyond. Even if not formally trained in DMH, social workers have a foundation training in micro and macro roles that are applicable to disaster response. Social workers were trained in the core concepts of PFA to provide \u0026ldquo;a humane, supportive response to a fellow human being who is suffering and who may need support\u0026rdquo; (WHO, 2011). PFA includes interventions such as listening, comforting, helping people connect with others, and providing information and practical support to address basic needs (Jacobs et al., 2016; Ruzek et al., 2007). Making explicit connections between social work practice concepts and focused DMH training with MSW students is a natural next step in preparedness. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePossible MSW Curricula Offerings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy participants reported strong interest in DMH modules as part of their practice coursework, such as an elective in DMH, the need for inter-disciplinary/inter-professional education, and the need for internships with organizations that provide DMH services. Hokenstad (2007) identified the need for social work education to consider curriculum options that include infusing disaster response into existing courses to expose a larger number of students to DMH as well as a specialization/concentration in the subject. There are a variety of online training opportunities that could serve as pre-disaster training options (Jacobs, et al., 2016; nctsn.org; redcross.org); however, while these opportunities create a volunteer network of mental health professionals, a more intentional training for social work students and professionals is needed. A few schools of social work currently offer DMH in a variety of ways (an undergraduate course, a 1 CEU course, a graduate certificate, an advanced/post-graduate certificate, a dual degree program, and a doctoral specialty track (www.usd.edu; www.du.edu; www.newpaltz.edu; www.sph.tulane.edu). Understandably, there are the multiple requirements for social work education; thus, there is limited room to expand curriculum options (CSWE, 2015). Infusing content within existing courses, elective courses, specializations, and additional certificate programs holds the most promise. It is vital that social work education continues to address the critical issues facing individuals, families, communities, and society at large (CSWE, 2018), such as the growing numbers of disaster events. Additionally, social workers often have the necessary leadership skills needed in disaster response, such as systems thinking, problem solving, relationship building, and team building (CSWE, 2018), further underscoring the need for social work training in DMH and disaster management dual degree options like the one offered at Tulane.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Future Training and Research \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe purpose of this capstone project was to design, implement, and evaluate a learning module for MSW students in the key concepts and skills of disaster mental health. Ideally, this learning module would be delivered again to allow implementation of the full module content alongside a student assignment with data collection to assess student learning more directly versus a self-report survey. The expanded sections of content could include a deeper dive into factors that impact readiness to respond, the importance of self-care, and more time for skill development and practice sessions. Also, replication of the learning module should occur with a more diverse group of participants to explore the cultural implications for learning and cultural implications for disaster service delivery with more diverse populations. This project has several implications for social work education. Study participants were receptive and expressed a desire to have more DMH content in the curriculum. Future research is needed to test out various curricular designs to determine if there are optimal places in the MSW curriculum for this area of study. Participants identified coursework for additional DMH training\u0026mdash;specifically specialized practice and an elective in disaster mental health\u0026mdash;for future consideration. Further curricula development could also include a post-graduate CEU option or certificate program. \u003c/p\u003e\n\u003cp\u003eThrough the literature review process, it became clear that multiple disciplines participate in disaster response. Young et al. (2007) asserted that DMH offerings could be an academic curriculum component across a variety of disciplines, such as school counseling, psychology, social work, nursing, teaching, and school leadership roles. Interdisciplinary coursework could benefit other fields, further preparing the helpers in our communities to respond to human-made or natural disasters in their communities. \u003c/p\u003e\n\u003cp\u003eThe field of DMH is evolving and a relatively young area of practice that expanded in the 1990s with the American Red Cross focus on DMH (Halpern \u0026amp; Vermeulen, 2017) and even more so after 9/11 (Strozier, 2011). Social workers can, and should, plan to play a vital role in this emerging area of practice since we have a micro, mezzo and macro focuses to our work. Social workers could plan a role in pre-disaster preparedness, organizing community training opportunities and developing intervention plans for the most vulnerable groups. Post-disaster, social workers could assist with community coordination, clinical service, and rebuilding efforts (CSWE, 2018). During the expert interviews, it was clear that there is a need for a collaboration across DMH experts on the next steps for this specialty area of practice. There continues to be lack of high-quality research on the effectiveness of DMH interventions as the unpredictable nature of disasters limits the ability of researchers to organize studies on DMH intervention. In the moment of disaster response, \u003cem\u003ethe focus is on the response\u003c/em\u003e\u0026mdash;not on gathering baseline data to then determine the impact of DMH on longer-term recovery (Reifels et al., 2014). This lack of research on the effectiveness of DMH intervention directly impacts the potential research on training of future social workers. \u003c/p\u003e"},{"header":"Summary","content":"\u003cp\u003eThe United States is experiencing multiple disasters, ranging from extreme weather events to human-made disasters to an international pandemic. These disasters impact individuals, families, and whole communities with emergent basic needs such as temporary shelter, food, and water, as well as psychological needs such as acute stress, grief, and hopelessness (Halpern et al., 2019). The goal of this project was to develop, implement, and evaluate a disaster mental health learning module for MSW students with the purpose of advancing the preparation of the field to respond to disasters in their communities and beyond. \u0026nbsp;This study provides preliminary data and support that an introduction to the key concepts and skills of DMH could be implemented in a variety of MSW coursework. This learning module requires further opportunity to present the full five-hour module and evaluation with direct student learning measure. When and if successful, the learning module can be disseminated to other MSW programs, thereby further preparing those entering the social work field to respond to disasters, human-made or natural, in their communities. \u0026nbsp;\u003c/p\u003e"},{"header":" Statements and Declarations","content":"\u003cp\u003eThe author has no relevant financial or non-financial interests to disclose. The author did not receive support from any organization for the submitted work. Approval was obtained from the IRB committee of Southern CT State University (SCSU). Informed consent to participate in the study was obtained. There are no competing interested to disclose that could bias the research. Datasets supporting the conclusions are available via SCSU capstone archive. No individual data or imagery was utilized thus consent to publish was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e This journey started on December 14, 2012—the day of the mass shooting at Sandy Hook Elementary School in Newtown, CT. On that day, twenty 1\u003csup\u003est\u003c/sup\u003e graders, six educators, and a mother were killed. I honor the lives forever changed by that horrific day, especially those of the Sandy Hook families and staff. By that evening, I was part of a team of committed mental health professionals whom had gathered at the Sandy Hook firehouse to aid in disaster response efforts. This project grew from service to that community, and I am grateful for the national and state experts who served as lifelines and guides along the way. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAdamson, C. (2018). Trauma-Informed supervision in the disaster context. \u003cem\u003eThe Clinical Supervisor\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(1), 221-240.\u003c/li\u003e\n\u003cli\u003eAmerican Red Cross. (2012). Disaster mental health handbook. Retrieved from: https://www2.cuny.edu/wp-content/uploads/sites/4/page assets/about/administration/offices/ovsa/disaster-relief/hurricanes-harvey-irma/Disaster-Mental-Health-Handbook.pdf\u003c/li\u003e\n\u003cli\u003eAmerican Psychological Association. (2019, August 15). 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Mass shootings: The role of the media in promoting generalized imitation. \u003cem\u003eAmerican Journal of Public Health\u003c/em\u003e. 107(3),368\u0026ndash;370.\u003c/li\u003e\n\u003cli\u003eMiller, L. (2008). Death notification for families of homicide victims: Healing dimensions of a complex process. \u003cem\u003eOmega\u003c/em\u003e, 57(4), 367-380.\u003c/li\u003e\n\u003cli\u003eNational Child Traumatic Stress Network. PFA and SPR. Retrieved from: https://www.nctsn.org/treatments-and-practices/psychological-first-aid-and-skills-for-psychological-recovery \u003c/li\u003e\n\u003cli\u003eNorth, C.S., Weaver, J.D., Dingman, R.L. et al. (2000). The American Red Cross Disaster mental health services: Development of a cooperative, single function, multidisciplinary service model. \u003cem\u003eThe Journal of Behavioral Health Services \u0026amp; Research\u003c/em\u003e, 27, 314\u0026ndash;320. \u003c/li\u003e\n\u003cli\u003eNorth, C. \u0026amp; Pfefferbaum, B. (2013). Mental health response to community disasters- A systematic review. \u003cem\u003eThe Journal of American Medical Association, \u003c/em\u003e\u003cem\u003e310\u003c/em\u003e(5), 507-518. doi:10.1001/jama.2013.107799 \u003c/li\u003e\n\u003cli\u003eNorris, F. H., Stevens, S. P., Pfefferbaum, B., Wyche, K. F., \u0026amp; Pfefferbaum, R. L. (2008). Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. \u003cem\u003eAmerican Journal of Community Psychology\u003c/em\u003e, 41(1\u0026ndash;2), 127\u0026ndash;150.\u003c/li\u003e\n\u003cli\u003eNuttman-Shwartz, O. (2015). Shared resilience in traumatic reality: A new concept for trauma workers exposed personally and professionally to collective disaster. \u003cem\u003eTrauma Violence \u0026amp; Abuse\u003c/em\u003e, 16(4), 466-475.\u003c/li\u003e\n\u003cli\u003eOsofsky, J. \u0026amp; Osofsky, H.J. (2018). 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Multiple Vantage Points on the Mental Health Effects of Mass Shootings. \u003cem\u003eCurrent Psychiatry Report\u003c/em\u003e, 14, 469. \u003c/li\u003e\n\u003cli\u003eState University of New York (SUNY) New Paltz. Trauma and disaster mental health. Retrieved from: https://www.newpaltz.edu/idmh/academic-programs/grad.html\u003c/li\u003e\n\u003cli\u003eSteele, W. (2015). \u003cem\u003eTrauma in schools and communities: Recovery lessons from survivors and responders.\u003c/em\u003e Routledge, New York, New York. \u003c/li\u003e\n\u003cli\u003eStreufert, B. (2004). Death on Campuses: Common postvention strategies in higher education. \u003cem\u003eDeath Studies\u003c/em\u003e, 28, 151-172. \u003c/li\u003e\n\u003cli\u003eStrozier, C. (2011) Until the fires stopped burning: 9/11 and New York in the words and experiences of survivors and witnesses. New York: Columbia University Press. \u003c/li\u003e\n\u003cli\u003eThompson, R., Jones, Holman, E., Silver, R. (2019). Media exposure to mass violence events can fuel a cycle of distress. \u003cem\u003eScience Journals\u003c/em\u003e, 5, 3502.\u003c/li\u003e\n\u003cli\u003eU.S. Department of Health and Human Services. (2015). Community Resilience. Retrieved from: https://www.phe.gov/Preparedness/planning/abc/Pages/community-resilience.aspx \u003c/li\u003e\n\u003cli\u003eWerner, D. (2014) Are school social workers prepared for a major school crisis? Indicators of individual and school environment preparedness. \u003cem\u003eChildren and Schools\u003c/em\u003e, 37(1), 28-35.\u003c/li\u003e\n\u003cli\u003eWintemute, G. (2015). The epidemiology of firearm violence in the twenty-first century United States. \u003cem\u003eAnnual Review Public Health\u003c/em\u003e, 36, 5\u0026ndash;19.\u003c/li\u003e\n\u003cli\u003eYoung, B., Ford, J., Ruzek, J., Freidman, M. \u0026amp; Gusman, F. (n.d.) \u003cem\u003eDisaster mental health services-A guidebook for clinicians and administrators. \u003c/em\u003e National Center for PTSD.\u003c/li\u003e\n\u003cli\u003eYoung, B., Ruzek, J., Wong, M., Salzar, M. \u0026amp; Naturale, A. (2007). \u003cem\u003eDisaster mental health training: guidelines, considerations, and recommendations in interventions following mass violence and disasters\u0026mdash;Strategies for mental health practice. \u003c/em\u003e Guilford Press.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-policy-practice-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jppr","sideBox":"Learn more about [Journal of Policy Practice and Research](https://www.springer.com/journal/42972)","snPcode":"42972","submissionUrl":"https://submission.springernature.com/new-submission/42972/3","title":"Journal of Policy Practice and Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Disaster response, mass shooting, disaster mental health, social work education","lastPublishedDoi":"10.21203/rs.3.rs-7624064/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7624064/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe United States is experiencing increased numbers of disasters; extreme weather events such as hurricanes, tornadoes and wild fires along with human-made disasters such as mass shootings and bombings. These disasters impact individuals, families, and whole communities with emergent basic needs such as temporary shelter, food and water, as well as psychological needs such as acute stress, grief and hopelessness (Halpern, Nitza \u0026amp; Vermeulen, 2019). Social workers are called to action as first responders and to aid in the ongoing healing process, yet most do not have pre-event training. This project provided an introduction to disaster mental health (DMH) training in MSW education through the development, implementation and evaluation of a learning module for specialized practice courses with the goal to strengthen the future social workers capacity to respond to disasters. The project was evaluated using an on-line, self-report, post-module survey. This study provides preliminary data and support that an introduction to the key concepts and skills of disaster mental health could be implemented in MSW coursework. The responses also indicated participants\u0026rsquo; pedagogical strategy and future course interests with most identifying this content as an appropriate venue for practice courses; an option of an elective in DMH and/or the need for inter-professional education. The results could inform future curriculum decisions and offerings within MSW/ post- MSW education.\u003c/p\u003e","manuscriptTitle":"Preparing Social Workers to Respond to Emergencies and Human- Made Disasters: Introducing essential elements of Disaster Mental Health in MSW education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-06 09:28:40","doi":"10.21203/rs.3.rs-7624064/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-17T23:02:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T03:32:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T00:39:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232828881318476928293016223496658453408","date":"2025-10-29T23:40:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2553689406123755752599870984947271565","date":"2025-10-21T18:05:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-23T18:22:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-18T18:04:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-16T23:42:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Policy Practice and Research","date":"2025-09-15T21:15:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-policy-practice-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jppr","sideBox":"Learn more about [Journal of Policy Practice and Research](https://www.springer.com/journal/42972)","snPcode":"42972","submissionUrl":"https://submission.springernature.com/new-submission/42972/3","title":"Journal of Policy Practice and Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"530c024e-8645-4801-b0df-aac34c331932","owner":[],"postedDate":"October 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:07:04+00:00","versionOfRecord":{"articleIdentity":"rs-7624064","link":"https://doi.org/10.1007/s42972-026-00144-8","journal":{"identity":"journal-of-policy-practice-and-research","isVorOnly":false,"title":"Journal of Policy Practice and Research"},"publishedOn":"2026-04-15 15:57:58","publishedOnDateReadable":"April 15th, 2026"},"versionCreatedAt":"2025-10-06 09:28:40","video":"","vorDoi":"10.1007/s42972-026-00144-8","vorDoiUrl":"https://doi.org/10.1007/s42972-026-00144-8","workflowStages":[]},"version":"v1","identity":"rs-7624064","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7624064","identity":"rs-7624064","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}