Resilient Sonoma

Nature of the Problem

Natural disasters like the 2017 North Bay fires are calamitous events—traumatic and customarily outside the scope of normal human experiences. Whenever and wherever they occur, they are situations in which the protective mechanisms of civil society are particularly likely to fail. Globally, there is an average of at least one disaster every day, but the frequency is rising with climate change, as are numbers of people involved are also increasing with greater population density. The morbidity caused by people’s exposure to trauma is rising, and increased number of psychosocial and mental health incidents are placing a rising burden on services that are often very stretched already. Children are uniquely affected by disasters because they are afflicted not only by the trauma of the event but also by their parents’ fear and distress. Following the trauma from the 2017 North Bay fires, many of our children, friends, family members, co-workers and neighbors are at risk for behavioral health crises, which, left unaddressed and untreated, can eventually become costly public health and social challenges. Evidence shows that the psychological impact of disasters is not always immediate, can last for years, and can catalyze other community health issues.

Program Description

To remedy this situation, Hanna Institute has partnered with the International Trauma Center to build and implement Resilient Sonoma, a comprehensive model for public mental health that provides a cost-effective continuum of evidence-based, trauma-informed care training and consultation. This innovative approach helps disaster-affected communities build resilience; ameliorate post-event trauma effects; and foster and sustain recovery in the face of adverse experiences. The model has three tiers: Tier 1 includes general population-based trauma interventions, such as community gatherings and educational opportunities, psychological first aid, and psychoeducation; Tier 2 is for more specialized group trauma interventions, such as skills for psychological recovery and a focus on trauma and grief; Tier 3 includes specialized individual-based interventions, such as psychiatric services for medication and trauma processing protocols for clients with primary and secondary PTSD. Effective implementation of this model requires a network of leadership that includes county government, school districts, law enforcement, public health agencies, primary care facilities, behavioral health services and faith-based communities. This networked approach forms the foundation to sustain the trauma-informed culture and improve intergenerational health.

Disruption

Traditionally, in the initial aftermath of natural disasters, a great deal of effort goes into the development of early support systems; however, the longer-term needs of disaster-affected populations are often underestimated. Widely-implemented approaches such as psychological debriefing or “grief work” that emphasizes working through one’s grief after a loss are typically beneficial for only a subset of individuals but ineffective or even harmful for most people. Thus, they are ineffective disaster behavioral health interventions. In contrast, Resilient Sonoma’s three-tiered, networked approach disrupts the traditional and ineffective siloed responses traditionally taken by various agencies. Instead, it provides a continuum of trauma-informed training and consultation for community nonprofits that have pre-existing relationships with their service recipients.

Leadership

Hanna Institute’s Resilient Sonoma model has led the creation of a broad network—including federal (FEMA) and county government, school districts, law enforcement, public health agencies, primary care facilities, behavioral health services and faith-based communities—that works collaboratively to improve and sustain a culture of intergenerational health and well-being. This has been accomplished by extensive engagement by our team and partners in assessing the immediate needs of at-risk populations and the capacities for toxic stress reduction, providing basic and advanced credentialing seminars in trauma-informed care/SAMHSA Evidence-Based Programs & Practices to both fire survivors and their caretakers, and by offering consulting to the collaborative in order to sustain recovery, build resilience, and meet the demands of exposure to future disasters.

Scalability

This replicable model can be implemented in communities suffering from natural disasters. Potential funders include community and private foundations that prioritize psychological recovery for their communities. Additionally, most nonprofits and government agencies have training/development budgets available to improve their service models. Since this program is not exclusive to licensed clinicians, there is the potential for more widespread dissemination of skill-building exercises for psychological recovery. Consequently, agencies can partner to share the costs. The efficient delivery of our model reduces duplicative expenditures and aligns existing resources. For example, to-date we’ve served 802 recipients at $202.79 per individual. Compared with the economic impact of longer-term PTSD treatment–academic failures, joblessness and medical complications–this translates into a potential cost savings of approximately $6,500 per resident. Assuming PTSD treatment costs roughly $4076 (estimate for military personnel) and considering the ineffectiveness of civilian medical utilization, we conservatively estimate treatment cost for residents/service providers to be $6,500.

Results/Outcomes

Our work has grown capacity of over 100 agencies—including school districts across Sonoma County as well as the county office of education, Sonoma County Human Services, Sonoma County Office of Recovery & Resilience, St. Joseph Health Care System, our local community health center, and many other nonprofits —by infusing their service models with evidence-based, trauma-informed, resiliency-focused tools. We also created a common language of trauma-informed care and resiliency-focused practices that allow hundreds of diverse providers to identify, assess and begin to mitigate the negative health trajectories caused by psychological trauma. Additionally, we established the daily practice of toxic stress reduction for hundreds of caregivers that protects them from secondary post-traumatic stress injuries. We are developing the structures to begin building and operating school-based behavioral health clinics in our local school district. We are integrating our Latinx population into the ‘mainstream’ care systems to enhance equity, access and cultural effectiveness.