About

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.

The following infographic addresses several key topics, including:

  • Revised “Phases of Disaster”, from Anticipation, to Impact, Adaptation, and Growth & Recovery
  • Stress Regulation Model, highlighting key drivers of resilient and less adaptive response paths
  • Focus on key stakeholder groups, including Survivors, Community Leaders and Responders, and specific expert guidelines for adaptive responses
  • A model of Community Stress Load which incorporates the impact of Foundational Issues, Chronic Stressors and specific Disasters
  • The “Community Balance Sheet”, a useful tool for specific communities to conceptualize and account for multiple, overlapping stressors in planning for all Stages of Disaster

Creators

Grant
Brenner, MD

Chief Medical Officer
The Collective - Integrated Behavioral Health

Grant Hilary Brenner is board-certified, and a Fellow of both the American Psychiatric Association and the New York Academy of Medicine. He is on faculty at the Mount Sinai Beth Israel Hospital, former Director of Trauma Service at the William Alanson White Institute and Co-Chair of Vibrant Emotional Health's Crisis and Emotional Care Team Advisory Board, Co-Chair of the Disasters, Trauma and Global Health Committee of the Group for Advancement of Psychiatry, and CEO and Co-Founder of Neighborhood Psychiatry. With Dr. Fara White, Dr. Brenner co-hosts the Doorknob Comments podcast. He is an experienced consultant, lecturer and teacher on subjects including resilience and self-care, psychotherapy theory and practice, trauma and neurobiology, organizational dynamics and disaster mental health. Dr. Brenner has appeared regularly in national media spots addressing a variety of subjects. He is sole author of the popular Psychology Today blog entitled ExperiMentations.

Sander
Koyfman, MD

Chief Medical Officer
Athena Psych

Dr. Sander Koyfman is a Psychiatrist with dual Board Certification in General Adult Psychiatry and Addiction Medicine. He is the Chief Medical Officer of Athena Psych - a NYC based clinic startup with focus on government programs, an independent consultant and most recently has served as Clinical Programs Behavioral Health Medical Director at Centene Behavioral Health with specific interest in measurable improvement in quality of care, Value Based Purchasing arrangements and promotion of Integration as a way to address parity and access to care. Prior to Centene he has served in a variety of clinical roles building and restoring services in a number of community settings. He graduated from New York University and completed his medical degree at the State University of New York Downstate Medical Center College of Medicine. He is a graduate of Mount Sinai Hospital Adult Psychiatry Program in New York City.

April
Naturale, Ph.D.

Assistant Vice President of National Programs
Vibrant Emotional Health

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.

Kathleen
Clegg, MD

Director of Ambulatory Psychiatry, Director of Community Psychiatry
University Hospitals Cleveland Medical Center

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.

James
C. West, MD

Scientist, Center for the Study of Traumatic Stress
Associate Professor, Psychiatry Uniformed Services University

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

Phases of Disaster

Chronic, cyclical disasters push a community through exhausting, recurring phases of anticipation, impact, and adaptation before a final recovery phase can begin

  • By characterizing the foundational issues, chronic stressors, and acute stressors already present in a community, we can more accurately assess the cumulative stress load for a given community when a chronic, cyclical disaster strikes.
  • By characterizing what is likely to occur in each phase, a community can enhance its adaptive capacity – its skills and strategies – to mitigate those expected stressors.
  • By characterizing each phase from the perspective of three primary groups (survivors, community leaders, and responders), we can better help each to understand “Where am I?”, “What’s coming next?”, and most importantly, “What can I do to most adaptively manage the stress?”

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?

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Regulating Stress Throughout the Phases of a Chronic Cyclical Disaster

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.

diagram
Time arrow

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

Faces of Disaster

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.

disasters

  • Survivors

    Survivors represent members of the impacted community.

  • Community Leaders

    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

    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.

Key Actions to Adaptive Mitigation of Stress

  • Anticipation
  • Impact
  • Adaptation
  • Growth & Recovery
Survivors

Survivors

  • Identify and promote survivors that have adapted well in prior similar experiences to work within their community

    Begin regular practices to help channel anxious energy, such as meditation
  • Give survivors with experience room to share memories and experiences

    Share access to correct and credible information
  • Participate in memorials for collective grief and closure

    Get involved in local projects that are planning for the post-disaster future
  • Integrate disaster experience

    Seek treatment for persistent mental health diagnoses
Community Leaders

Community Leaders

  • Clearly message quality information in risk communication

    Provision anticipated needed resources
  • Leverage just in time partnerships to address the most immediate needs

    Promote actionable information from trusted resources
  • Evaluate and restore basic functions (e.g., schools) with appropriate modifications

    Build resources and resilience for high-risk subgroups and conduct planning to avoid returning to pre-disaster neglect
  • Encourage restoration of productive relationships between subgroups

    Address competition and resentment between subgroups that has persisted or evolved
Survivors

Responders

  • In planning, capture lessons learned from other communities (if initial onset) or from earlier cycles (if this is a new cycle)

    Address existing or anticipated burnout
  • Focus on training and community building

    Address responders’ needs to keep own families safe by offering co-sheltering and shared resources
  • Advise and support responders to feel empowered to continue the work without the influx of outside help

    Enlist disaster mental health experts to support responders at risk of burnout
  • Integrate lessons learned into future response, training, and preparation

    Monitor and seek help for consistent and severe stress

Community Stress Load Threshold

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.

Measure the Cumulative Stress Load in a Community

  • Acute Stressors

    Health crisis, economic, crisis, environmental crisis, and police-community conflict (Disaster 1 & 2)

  • Chronic Stressors

    Violence, poor population health, housing instability, lack of political representation, and population loss

  • Foundational Issues

    Unemployment, low trust in institutions, intergenerational poverty, discrimination, etc.
Mitigating the Cumulative Stress Load in a Community

Stakeholders can strengthen Protective Factors and address Imparing Factors to stay below the load threshold.

  • Anticipation
  • Impact
  • Adaptation
  • Growth & Recovery
diagram

Community Balance Sheet

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.

sheet