This Chronic Cyclical Disaster Model (© 2022) was developed out of a three-way collaboration between Vibrant Emotional Health’s Crisis Emotional Care Team, the Group for the Advancement of Psychiatry’s Committee on Disasters, Trauma and Global Health, and Decision Point Systems.
Precipitated by the chronic, recurring disaster of the COVID19 pandemic, and superimposed natural disasters, forest fires and mass casualty events, we saw a pressing need to develop a framework for key stakeholders to make sense of and stage responses to the increasingly frequent and complex array of disaster events we face in contemporary society, superimposed atop chronic psychosocial and socioeconomic stressors.
April Naturale, Ph.D., is a traumatic stress specialist with 30 years of experience as a health/mental health care administrator, and a clinician specializing in response to traumatic events. Dr. Naturale directed the New York State mental health response to 9/11, served as project director for the Substance Abuse and Mental Health Services Administration’s Disaster Technical Assistance Center (SAMHSA DTAC), helped launch the National Suicide Prevention Lifeline, the BP Oil Spill Distress Helpline and the National Disaster Distress Helpline. She was the architect of the Boston Marathon Bombing Behavioral Health response has been the program consultant for the San Bernardino terror attack and the TN Christmas Day bombing as well as the Las Vegas Harvest Festival, Pulse Nightclub, Parkland, Thousand Oaks, Pittsburgh Tree of Life, Virginia Beach, El Paso and Highland Ranch shooting incidents. For the past five years she has trained Psychologists in the Ukraine Military Service, Humanitarian Aid workers for the European Union and recently helped launch the new European Centre of Expertise for Victims of Terrorism. Dr. Naturale has returned to Vibrant Emotional Health as the AVP of National Crisis and Wellness Services.
Dr. Clegg, an Associate Professor of Psychiatry, has been involved in clinical service, education and administration in psychiatry throughout her career. Board certified in Psychiatry and Addiction Psychiatry, Dr. Clegg serves as the Director of Ambulatory Psychiatry and Director of Community Psychiatry at University Hospitals Cleveland Medical Center. For more than 20 years, she has taught in the course “Management of Complex Humanitarian Emergencies: Focus on Children and Families” nationally and internationally. Dr. Clegg serves as Co-Chair of the Trauma, Disaster and Global Mental Health committee of the Group for the Advancement of Psychiatry (GAP). Dr. Clegg also serves as the Co-Chair of the University Hospitals Cleveland Medical Center Trauma Initiative. Special interests include Community Psychiatry, Addiction Psychiatry, Trauma, Compassion Fatigue and Vicarious Trauma, Disaster Psychiatry and Global Mental Health. She is a faculty member at the Gestalt Institute of Cleveland, and has served as a co-chair and faculty member is several workshops and training programs.
Dr. West is Associate Professor of Psychiatry and a Scientist at the Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences. He earned his Bachelor of Science in Engineering from the United States Naval Academy in 1989 and served eight years as a submarine warfare officer in the Navy prior to earning his M.D. from the University of Michigan Medical School in 2001. He completed residency training in psychiatry at Naval Medical Center Portsmouth, Virginia. He has worked as a military psychiatrist with First Marine Division in Camp Pendleton, California and National Naval Medical Center, Bethesda, Maryland. He deployed in 2006 to Fallujah, Iraq as Operational Stress Control and Readiness (OSCAR) psychiatrist for Regimental Combat Team 5 and in 2010 to Helmand Province, Afghanistan as Combat and Operational Stress Control Officer for Combat Logistics Regiment 15. He served on the leadership team integrating National Naval Medical Center with Walter Reed Army Medical Center as Assistant Deputy Commander and Deputy Commander of Behavioral Health. In 2013, he joined the faculty of Uniformed Services University of the Health Sciences where he has continued to work following retirement from the Navy in 2019.
Chronic, cyclical disasters push a community through exhausting, recurring phases of anticipation, impact, and adaptation before a final recovery phase can begin
Higher risk groups are likely to experience disaster differently than the general population. These groups are likely to be both disproportionately negatively impacted and experience inequity in aid and response. Higher risk groups include underrepresented communities such as racial minorities (such as Black, Indigenous communities, Asian, Pacific Islander, Latinx), religious minorities, ethnic minorities, people with disabilities, the LGBTQ+ community, people with low income, people residing in rural and remote areas, refugees/displaced communities, and others. Community leaders and responders must identify and assess these higher risk groups to ensure more equitable response.
The duration and intensity of each phase is highly dependent on the nature of the disaster
How Do We Reach Recovery?
The phases of a chronic, cyclical disaster will cause various levels of stress. In response to this stress, there is a spectrum of adaptive (healthy) to maladaptive (unhealthy) responses that survivors, the community, and responders can have. Achieving adaptive stress regulation through each phase requires different actions by each group. Example key actions that will help each group stay close to the zone of healthy stress regulation are provided below the schematic.
If left unmitigated, survivors, the community, and responders will find themselves in the Purple and Red zones of extreme distress. More adaptive actions by individuals and leadership will keep these groups in the Zone of Healthy Stress Regulation
Each “face” or group experiencing a disaster is composed of various subgroups. Higher-risk communities may be more directly and severely impacted by the disaster. Higher-risk communities may also experience inequity in response efforts.
Survivors represent members of the impacted community.
Community Leaders represents leadership and institutions of power and/or influence in the community. Examples include government officials, religious leaders, and other civic and social network leaders.
Responders represents the group of professionals called upon in the face of a disaster or emergency to protect the lives, property, and overall safety of community members.
A community’s capacity to absorb the shock of a chronic disaster, such as a pandemic, depends on the foundational issues and stressors already present in the community. A community accumulates stressors that, once reaching a threshold, can make it difficult for the community to function.
Stakeholders can strengthen Protective Factors and address Imparing Factors to stay below the load threshold.
Communities may have ongoing disasters that can cause stresses on community resources. With the proper productivity by the Community, Survivors, and Responders within each phase, these overlaid crises can be mitigated to improve the community’s faculties.