Early Interventions

Preparation

When traumatic events impact individuals or families, the timing of intervention depends on the timing of help seeking or referral. When events may affect multiple individuals, it is important that trauma and other community specialists be prepared for the potentially chaotic nature of the aftermath and for the stages of response. Ongoing liaisons should be established before potential events, with community officials, police, firefighters, media officials, hospital leaders and personnel, and school and community leaders. Preparatory procedures and guidelines should be established. Especially if normal methods of communication are impeded, locations where individuals might seek information must be identified. It may be important to use these locations (e.g., churches, schools, barbershops, other gathering spots) in addition to local media to disseminate information or offer assistance. On the other hand, it may be important to route individuals away from some locations (e.g., bombing or other disaster sites, hospitals) for safety's sake and/or to free roadways, entryways, or danger zones for emergency vehicles and intervention efforts. Exit strategies, potential safe zones and shelters, emergency supplies, and methods of dissemination may be identified or established in advance and made adaptable to varied circumstances that may follow events for different groups.

The Timing and Focus of Interventions

After acute reflexive responses to traumatic or other adversity, reactions are simultaneously psychological and neurobiological adjustments made to promote coping and survival. They are modulated by appraisals of threat, subjective meanings attributed to the adversities as they unfold over time, and the extent to which self-esteem is undermined or is sustained or strengthened through effective coping. The neurobiological, emotional, cognitive, and behavioral disequilibrium that emerges will either assist resolution or beget persistent anxiety and depression.

[Page 220]The timing and focus of assessments and interventions can be an important determinant of resolution versus persistence.

Assessment

Before assessment, restoration of safety and attention to basic needs is paramount. Additionally, because some individuals will have initially heightened levels of arousal, anxiety, and other symptoms that may subside within 2 or 3 weeks, while other individuals may be numb and unable to report symptoms, screenings carried out before this time period may result in some false-positive or false-negative assessments. When assessments are carried out, because of their associations with outcomes, screenings should include assessments of exposure variables, peritraumatic emotions, history of trauma, family and other support systems, demographics, and preexisting disorders, as well as diagnostic assessments. Initial response teams can assess status and help to promote resolution by focusing on the extent to which trauma or adversity-evoked reactions succeed or fail to engender a sense of coping and mastery.

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