LOGO GEAR

LOGO GEAR

Peripheral-Immediate Victims (PIVs)PV1. Persons in nearby buildings who witnessed a plane hit the first or second Tower, individuals living in the vicinity of the disastrous implosions who witnessed the fire, smoke, ashes, bent steel, and flying debris, as well as seeing people running to get away from the towering inferno.
PV2. This subcategory includes emergency rescue workers, emergency medical workers, on-site crisis mental health providers, and media reporters. It is understood here that many PVs may actually be DVs: some emergency workers’ actual exposure to traumatizing stimuli may be at greater risk for traumatic symptoms and disorders.

Relational Victims (RVs)RV1. Children who lost a parent in the disaster.
RV2. Bereaved individuals with children whose spouse was killed in the disaster.
RV2. Bereaved individuals whose spouse was killed in the disaster.
RV3. Individuals whose friend or friends perished in the rubble.

Vicarious Victims (VVs)

Persons deeply affected by the deaths and destruction witnessed on television and other news stories and images of planes repeatedly hitting the WTC buildings. This classification of affected people can be found in New York, throughout the United States, as well as around the world.

Stressors of First Responders—Firefighters, Police Officers, and Emergency Workers

First response personnel are at high risk for severe post-traumatic stress, and serious health problems. For example, first responder teams at the WTC were exposed to:

• The experience of day-to-day exposure to an environment of ubiquitous destruction and death immersion.
• Exposure to mass violence.
• Chronic levels of fatigue.
• Exposure to bits and pieces of human remains, which may include parts of fellow FDNY and NYPD victims.
• Exposure to decaying, putrid human remains

• Exposure to extreme environmental toxic, chemical substances
• Exposure to precipitate from tons of debris—particles in powder form consisting of ground glass, ground concrete, asbestos, and an incredible cocktail of multiple chemicals from computer chips, plastics, gas fumes, and radioactivity.
• Sudden-death-at-any-moment stress (as recovery workers do their work at “Ground Zero”).

Stress Reactions of First Response Teams

First response teams may experience the following traumatic stress responses:

• Uncontrolled exposure due to passionate, intense desire to find/recover remains of fellow firefighters (“FDNY as Family—firefighters as brothers”).
• Self-imposed exposure.
• Identification stress (identification with dead fellow firefighters ).
• Feeling tainted by death.
• Incapacity to disengage from recovery efforts.
• Survivor guilt (“Why he and not me?”).
• Sensory reliving: “Smell of death.”
• Sensory reliving: “Sight of death.”

• Sensory reliving: “Skin contact of death.”
• Sensory reliving: “Whole-body memories.”
• Chronic medical illnesses, especially respiratory
• Inability to grieve.
• Persistent sense of failure (due to unrealistic intention of finding and recovering all the injured and dead).
• Profound impacted grief.
• Experiencing the “death taint.”
• Resurgence of prior traumatic experiences.

COPING WITH DISASTER TRAUMATIC STRESS RESPONSE

Helping Children Cope

Children are often profoundly affected by disasters, and reveal such responses as fear, anxiety, moodiness, emotional ups and downs, feelings of revenge (seen chiefly in High School youths), grief, sadness, worries about safety in the present, and in the future. Other stress responses seen in children and youths involve anger—motivated to regulate fear and internal confusion, and gain some sense of self/environmental control. In High School children this anger may be intense, and build into feelings of revenge against perpetrators and others who resemble them in physical appearance. Behaviorally, some children will show uncharacteristic whining for attention, clinging behavior (especially in young, school age children), withdrawal, and outbursts of anger, defiance, suspiciousness, school avoidance, and truancy. Some children are expected to show depression, especially children and youths who were in a close vicinity to the disaster. Children and youths report denial, and ruminative thinking about war, Anthrax, and future terroristic threats.

In addition to psychological stress responses, there are also responses that involve the child’s body: repetition of traumatic distress in the form of stomachache, headache, irritability, and mood changes. Sleep disturbance and associated physical exhaustion and fatigue may be seen in adolescents, while others will show a loss of previous developmental achievement as seen in bladder and bowel dyscontrol (enuresis and encopresis). Academic performance often declines as a function of fear, fear of failure (not present before the disaster event), avoidance, concentration and attending problems, and hyperarousal, anger, irritability, and diminished motivation. What can parents, teachers, and surrogates do to reassure and comfort their children?

• Reassure, reassure, reassure! About safety, safety, safety! Focus on safety and offer credible reasons why they are truly safe (“I know you are safe because …”).
  
• Listen to them—hear and understand their reports, thoughts, and feelings, because what they have to say expresses important meaning for them.
  

• As parent or teachers continually reassure and reiterate safety and security to the child, interweave their own concerns and fears with your explanations.
  
• Look for changes in the child’s behavior—in the home, school, in his or her relationship with peers, and degree of “comfort” with spending time alone—in isolation from others.
  

For more information on the interventions with children, the reader is referred to Gift From Within’s Website

Post-Event Processing and Debriefing (EPD)

When the victim’s stress responses are persistently distressing for three or more weeks, this writer recommends direct intervention by a trauma-trained professional with disaster traumatic stress experience. Thus, victims who continue to suffer from hyperarousal and cardiac reactivity, persistent lack of joy (compared prior to before the disaster), persistent unbidden thoughts about the trauma, startle reactions, inability to work, overuse of drugs or alcohol, and diminished capacity to give and receive love in intimate relationship—required specialized intervention.

Psychological debriefing (PD) is widely accepted as a primary form of early intervention for disaster victims. But its widely accepted role and value in preventing the development of PTSD has been discredited as a universal panacea for disaster victims. In fact, research evidence shows that PD not only fails to prevent PTSD and other traumapathology, but that it may prove harmful. The reasons may be multiple and complex, but one is advanced here. It is possible that, rather than the effects of PD helping victims progress to extinction of stress-based hyperarousal, the actual effects may create trauma-sensitization, deepening victim’s distress and disability. It seems that the most important value of PD is its ability to help first responder teams process emotional responses, as they share emotions, receive emotional support, and get information to help them understand their stress responses. Another PD benefit is the reduction or elimination of alcohol or drug abuse in victims.

Since PD means many things to many people, and its practice, contents, and applications are still confusing and in need of empirical clarification, EPD was coined to deal with these and other limitations of ordinarily practiced PD. EPD is characterized by a number of strategies and procedures:

• Impart basic trauma information (education about trauma dynamics, symptoms, and what is available in terms of interventions for themselves family members represent a first series of steps.
  
• Ensure that immediate psychological, medical, and material sources needs are met.
  
• Social support network.
  
• Techniques are clinical (with no apologies, as opposed to CISD’s non-Clinical).
  
• Features multiple sessions (compared to CISD’s single- session format).
  
• Sessions are short and manageable (45 minutes each sessions as opposed to CISD’s single session lasting three or four hours).
  

• Initial screening.
  
• Initial assessment.
  
• Specific techniques to assuage hyperarousal.
  
• Specific techniques to manage stress.
  
• Specific techniques to manage catastrophic cognitive tendency through cognitive restructuring.
  
• Opportunities for individual and group sessions conducted in a noncoercive, democratic environment several days after the disaster (not in the first few days after the disaster).
   
   
   
  

• Disaster trauma, especially when human engineered, carries with it serious consequences and impairments—in sexual desire and functioning, Victims with a history of cardiovascular disease, major depression, substance abuse, and other mental disorders are at risk for severe forms of distress and dysfunctions.
  
• Trauma creates alterations in neurochemicals and immune systems that may lead to significant medical problems, and undermine the body’s recovery from illnesses.
  

In this writer’s experience in New York City post-911, many reluctant victims appeared to fear learning more about traumatic stress. Some seemed to believe that ignorance is bliss: that the less they knew the less the burdens and distress would be. These victims required specific educational materials to take home, read, and offer feedback to a therapist or designated individual or family members. They were encouraged to engage information-gathering sessions rather than therapy per se. Additionally, some found the concept of later treatment easier to accept with sensitive talk about the need to avoid the ills of traumatic stress, that therapy works, and that they need not consign themselves (DVs and PIVs) to a life of suffering alone.

Post-Disaster Phases:
From Acute Distress to Healing and Integration

The author’s experience and extant trauma and disaster clinical and research literature identify a number of phases people go through on the road to recovery (Brende, 1998; Brende & Parson, 1985; Parson, 1995a, 1995b, and Raphael, 2000) have identified five stages. Naturally, the time it takes for a particular victim to traverse these phases is expected to differ, depending on a number of variables—intensity of exposure, personality factors, resources availability, quality of social support networks, and the capacity to process fear, anxiety, and catastrophic cognitive processes. These phases, as conceptualized here, are meant to offer only a general point of reference (or benchmark) to portray the normal stress recovery process, and what can interfere with this process, and produce a mental disorder. Thus, the specific phase the victim is going through at the time may inform the particular intervention or non-intervention needed by a particular victim.

This writer’s experience shows that disaster trauma victims use specific coping strategies based on the particular phase (or natural recovery configurations of symptoms being processed) at a given time after the trauma. It is recognized here that most people affected in the wake of disasters do not suffer PTSD in the immediate aftermath. A small percent of victims do reach criteria for PTSD in the immediate aftermath of a disaster. Many victims will experience evanescent stress responses that will abate over time. Though it is well known that a diversity of responses—based on individual differences, mental state and physical health status, prior trauma, etc.—can be expected among victims, it is also established that patterns of response may be based upon the natural processing of the trauma in the minds and bodies of those affected.

Certainly, the role of denial is quite remarkable: some victims do not believe they need help from anyone—family, friends, nor professionals—to successfully recover from post-traumatic stress. Becoming stuck in this position is perhaps one of the most harmful places to be for DVs and PIVs. This belief may prove detrimental in that it may prevent distressed victims from seeking and benefiting from stress-ameliorating social networks and engaging in normal routines. Most people overcome the adverse effects of disasters, and go on to benefit and find positive outcomes.

The proposed phases often overlap. They are: Emergency Adaptational Coping (EAC); First Stress Response Control (FRC); Reenactment and Mastery (RAM); Cynicism and Reflective-Transformation (CRT); and Trauma Resolution Vs. Stress Disorder (TRvsSD).

Phase 1—Emergency Adaptational Coping (EAC)

During this first phase of the disaster recovery process the victims experience their lives as being threatened and respond with fear, shock, disbelief, horror, helplessness, and an accompanying physiological “fight-flight” activation of pulse, blood pressure, respiration, heart rate, muscle activity, and release of such hormones as adrenaline. This phase begins immediately after the disaster.

The September 11^th attack on the World Trade Center was a shocking event that has profoundly affected Americans and the world. According to people who were inside the imploding Towers, and those in the vicinity of the disaster, and falling debris, smoke, and flying body parts, glass, and metal, the event was traumatically memorable, and emotionally painful. Shattering of the sense of self and reality accounts for the feeling of unreality, strangeness, and disorientation mentioned to me by many traumatically shocked victims. As is true of many other kinds of disasters, peoples worried about the quality of the air they were breathing in the City, many having heard of the potentially toxic cocktail of lead, asbestos, and other noxious substances in the air. Twenty-five percent of disaster recovery workers at “Ground Zero” complain of serious respiratory problems.

Doing Post-Event Processing and Debriefing (EPD) with victims of disasters, this author focuses on helping victims to normalize their daily routines, and formulate and develop effective coping strategies. Contemporary ideas on early debriefing will be discussed later in this article when the fifth phase of the recovery process is presented. Many victims and family members seen complained of shock, fear, grief, anger, empty, and of having lost a sense of innocence. But they spoke, above all else, of not being able to relax—of being hypervigilant, hyperalert, distrustful. Many stated that the inner pieces no longer fit, as they realized that their lifelong held assumptions about the world as safe, stable, predictable, rational, and fair were shattered. Now, they were forced to re-evaluate their own prior beliefs about safety, predictability, and universal goodness. Meeting victims’ immediate practical needs for solving resources problems is also very useful during this phase.

The preferred approach to helping victims during the EAC phase is to offer vital trauma information, and teach the necessity for seeking and receiving sustenance from naturally-occurring support networks—family members, friends, member of the community, the clergy, and others. These networks offer potentially healing presences of people who are available for empathy, sympathy, and emotional nurturing. Immersion in social networks is more than mere support in the ordinary sense: The network ensures human connections that help victims process their trauma on the emotional level, effecting changes on the neurobiological level as well. Also, these connecting networks help overturn victims’ deleterious avoidance tendency to isolate and avoid interactions with people and the general post-trauma environment. Informal groups consisting of victims, family members, and other victims of previous trauma in sync with the new victims, are helpful in finding emotional resolution and integration.

Victims are also encouraged to continually strive to discover new strategies for relaxation. But the relaxing being recommended here is not just sitting down in a quiet place, watching television, and sipping a favorite beverage. Since stress-related hyperarousal is a culprit in the evolution of normal stress into PTSD (a serious health problem with the potential for disrupting the individual’s entire lifeline), relaxing (or stress management) takes on a very special and pressing significance. As a relatively severe and noteworthy stress response, hyperarousal is associated with panic attacks, emotional dyscontrol and lability, increased heart rate and respiration, sleep problems, being easily startled, irritability, agitation, cardiovascular reactivity, and the subjective sense of internally “falling apart.” Hyperarousal during this early phase predicts PTSD (Brende & Parson, 1985; Bryant et al., 2001; Shalev, 1998), as does dissociation—feeling dazed, stunned, numbed to the reality of the calamity (Brende, 1998), and disconnected from parts of self. If severe distress from these symptoms persists after three months and interfere with the individual’s daily functioning, professional intervention that include traumatherapy and drug therapy may be necessary.

This writer convinced many New York City victims to turn off the television, and to shut out trauma-related stimuli as a daily practice for days or weeks. Additionally, some persons did daily physical exercise to relieve stress, while inducing feelings of calm and sense of control over their minds and bodies. Some found a re-commitment to faith and religious practice to be a calming and reassuring presence, reducing hyperarousal and associated problems.

Victims are encouraged to go easy, and allow self to heal at its own pace. Patience will be required here. They’re also implored talk frequently about the emotional climate that now dominate their internal lives. For some, talking will be difficult; but there is a way out for them. Because of the convincing evidence from research and clinical observation, this author encourages victims to engage in surface journaling (recording their fears, anxieties, catastrophic expectations, sadness, and grief, as well as feelings of elation, triumph, and positive vistas and insights on paper). This form of mental exercise is an excellent counterpart to highly recommend physical exercise, good, nutritious eating, stretching, walking, adequate sleep, and maintenance of normal actional routine, dancing, art, and laughter.

The EAC phase is key to preventing PTSD, and it is during this phase that primary care screening for stress symptoms and PTSD is most emphatically recommended. Clinical experience and scientific studies strongly recommend the use of brief screening devices to gather key information to be used to identify persons at risk for PTSD, and especially chronic forms of the disorder. Identification of risk factors is imperative during this time, among these may be added poverty and lack of essential resources, homelessness, and chronic medical illness.

Victims with a history of trauma, mental disorder, family psychiatric history, impoverished social supports and resources, need to be identified early to receive appropriate interventions, even during the EAC phase. In such cases it would be prudent for professional helpers to obtain informed consent from victims (Gist and Woodall, 2000). Specific instruments that assess PTSD, severe bereavement reaction, depression, substance abuse, eating disorder, panic disorders, psychotic symptoms, and other mental disorders.

Intense psychological debriefing in which painful memories are resurrected and revivified, is to be avoided during this phase. Any memory-activating procedure may prove to paradoxically prove harmful, failing to produce the expected positive therapeutic outcomes. This writer does not see victim assistance during this phase to be “treatment” or “psychotherapy” in the ordinary sense.

Phase 2—Stress Response Control (SRC)

While the EAC phase represents the time when the victim was caught off guard by an onslaught of overwhelming stimuli, the first response control phase is when the victim’s mind and body attempts to take back control. This phase begins immediately after the traumatic event, and extends to the eighth and twelfth weeks. The first psychobiological event in attempting to heal from disaster trauma is the mind’s own imposition of control over being “swept away” by torrents of powerful emotions, disorganization, and sense of helplessness. The victim attempts to transform disorganizing shock, mental confusion, and hyperarousal of the Emergency Phase into a new mental state that offers control—in the form of emotional numbing, denial, and avoidance of the untoward effects of the disaster upon one’s life. Thus, in this phase the survivor protects self by burying the traumatic experience in the mind and body (Brende & Parson, 1985).

Numbing and disbelief yield relief from the emotional shock and internal torture of the trauma, but with this relief the victim’s mind evolves to an awareness of being alive and safe, and the associated self-responsibility. Then, realization and the need for action become preeminent. Providing the stress responses are within tolerable limits for the victim, it is recommended that stress management procedures are used frequently. The procedures include includes one hour a day stretching, breathing, meditation, progressive relaxation, and group support. These awareness, concentration, as they quiet down the mind and body.

Phase 3—Reenactment and Mastery (RAM)

Whereas Phase 2 was characterized by a false sense of all-powerfulness in which numbing and an “above-it-all” denial were key factors, this phase is marked by a false sense of all-powerlessness in which reenactments of the past prove internally overwhelming. During this phase the victim experiences painful memories and a sea of turgid emotions. He or she now is caught up in the realization that life has been permanently altered, and that pre-trauma life is gone forever. RAM is characterized by intrusive thoughts that alternate with numbing and denial. This biphasic processing of trauma is motivated by the mind’s search for a means of mastering the painful memories and emotions associated with the disaster. This processing then leads to reappraisal and realization as the trauma is assimilated into the victim’s pretrauma personality. This processing takes into account the meaning of coming close to death yet remaining alive as recovery and reconstruction moves ahead (Brende, 1998; Brende & Parson, 1998; McFarlane & Raphael, 1984).

The alternating between intrusion and numbing is motivated by a biological, subconscious need to master the trauma, and thereby ameliorate the extremes of deep numbing (so closely associated with death and vulnerability in the mind) and disquieting intrusion (so closely associated with being out of control, leading to dissolution of the self). Complicating life in this phase is the accompanying awareness of contending with injuries, job and career setbacks, altered relationships at home and work, repairing property, relocation, role changes, and a lost of past innocence about self and world. Sleep disturbance is prevalence during this phase.

Phase 4—Cynicism and Reflective-Transition (CRT)

The realization of loss, the general alteration of one’s life, and failure of the authorities to warn and protect against the disaster, may lead to hostility and cynicism in victims. These issues often begin early in the stress recovery process, and persist for several months often with intensity. Victims who had tried to be patient and adapt to a new post-trauma reality may now be feeling rebellious, irritable, cynical, as they complain and show increased irritability, intolerance, and distrust of people. They often feel mistreated by powerful people who neglect, are dishonest, and show little caring for the victim’s plight. In the absence of humor, and their distrust of people who were spared the trauma, as well as the neglecting authorities, victims may be prone to angry or even violent outbursts in close relationships. Making things worse, some victims also suffer physical symptoms, may complaint of headaches, nausea, vomiting, muscle aches, chest pain, restlessness, sweating, general fatigue (Brende, 1998; Brende & Parson, 1985; Dahl, 1989), and the complication of alcohol or drug abuse. Some will suffer with significant physical symptoms, pain, and disability, deepening anger and cynicism.

During this phase, additionally, there is room for a positive transition based upon reflection and development of a larger personal perspective on the trauma. Here, the victim thinks more about the future than about the past (Brende & Parson, 1985). Though earlier in this phase victims appear to be more affected by loss than they are by gain and advantage, their focus now is on gratitude, and awareness of personal growth, and the future of possibilities (at being alive and surviving one’s own mortality). The last phase, as conceptualized here, is ushered in either when the victim transitions to developing a positive perspective on the trauma, or maintains traumatic mental and behavioral patterns.

Phase 5—Trauma Stress Renewal Vs. Onset
Of Stress Disorder (TR/SD).

Most victims exposed to mild to moderate psychological trauma will, as noted before, recover within weeks or months. However, for those victims whose stress responses get worse rather than remit over time, the more likely it is that they will require interventions that go beyond ordinarily psychological debriefing. Generally, after four to six weeks victims will either resolve post-traumatic stress symptoms or find their symptoms are getting worse, becoming ingrained in their minds and bodies. The symptoms of flashbacks, hyperarousal, nightmares, numbing and avoidance, guilt, anger, resentment, irritability, depression, panic attacks, sleep disturbance, and depression may deteriorate into a chronic PTSD and PTSD comorbidities (multiple mental disorders). According to research studies, victims’ gender, age, degree and duration of exposure, prior trauma, negative recovery environment, and the absence of supportive social networks or relationships determine the PTSD outcome.

Preventing normal acute stress disorder from evolving into full-blown PTSD should be done whenever possible. If the goal of intervention is reduction of hyperarousal, catastrophic cognitive tendency, and helplessness then research has demonstrated that the most effective treatment for PTSD is cognitive-behavioral therapy with an exposure-based organization (Foa, Hearst-Ikeda & Perry, 1995; Bryant, Harvey, Dang, Sackville, and Basten, 1998; Smyth, 1999). What is still not very clear is whether reduction or management of distress is the best outcome over time for victims. In situations where the disaster trauma was caused by human design, therapy may also need to go beyond symptom relief to dealing with internalized attitudes about dreadful people.

ReferencesAmerican Psychiatric Association (1994). Diagnostic and Statistical Manual of MentalDisorders, Fourth

    Edition. Washington, DC: American Psychiatric Association.
Ballou, C. (2001, October 23). Does WTC Attack Have a Unique Effect on Veterans? Caribbean Life—

    Brooklyn and Staten Island, p. 22.
Brende, J. O. (1998). Coping with Floods: Assessment, Intervention, and Recovery

    Processes for Survivors and Helpers. Journal of Contemporary Psychotherapy, 28, 107-140.
Brende, J. O. & Parson, E. R. (1985). Vietnam Veteran: The Road to Recovery. New

    York: Plenum Publishing Corporation.
Bryant, R. & Harvey, A. (2000). Acute Stress Disorder: A Handbook of Theory, Assessment, and

    Treatment. Washington, DC: American Psychological Association.
Bryant, R. & Harvey, A. (1997). Acute Stress Disorder: A Critical Review of Diagnostic Issues. Clinical

    Psychology Review, 17, 757-773.
Bryant, R. & Sackville, T., Dang, S., Moulds, M. Guthrie, R. (1999, November). Treating Acute Stress

    Disorder: An Evaluation of Cognitive Behavior Therapy and Supportive Counseling Techniques.

    American Journal of Psychiatry, 156, 1780-1786.
Foa, E., Hearst-Ikeda, D., & Perry, K. (1995). Evaluation of a Brief Cognitve-Behavioral Program for the

    Prevention of Chronic of Chronic PTSD in Recent Assault Victims. Journal of Consulting

    And Clinical Psychology, 63, 948-955.

    Nervous and Mental Disease, 187, 661-672.
Lonigan, C., Anthony, J. Shannon, M. (1998). Diagnostic efficacy of post-traumatic symptoms in children

    exposed to disaster. Journal of Clinical Child Psychology, 27, 255-267.
McDermott, B., & Palmer, L. (1999). Post-disaster service provision following proactive identification of

    children with emotional distress and depression. Australian and New Zealand Journal of

    Psychiatry, 33, 855-863.
McFarlane, A. & Hua, C. (1993). Study of a major disaster in the People’s Republic of China: The

    Yunnan earthquake. In J. P. Wilson & B. Raphael (Eds.), International Handbook of Traumatic

    Stress Syndromes (pp. 493-498). New York: Plenum Press.
National Oceanic and Atmospheric Administration, 2002). Billion Dollar U.S. Weather Disasters, 1980-

    2001. National Center Climatic Data Center (NCDC), January 1, 2002.
Parson, E. R. (1994). Post-Traumatic Stress Disorder: Its Biopsychobehavioral Aspects and

    Management. In B. Wolman & G. Stricker (Eds). Anxiety and Related Disorders: A Handbook

    (pp. 226-285). New York: Wiley.
Parson, E. R. (1995a). Adaptational Coping with Mass Traumatic Terror. Journal of Contemporary

    Psychotherapy.
Parson, E. R. (1995b). Adaptational Coping with Mass Traumatic Terror. Journal of

    Contemporary Psychotherapy.
Raphael, B. (2000). Disaster Mental Health Response Handbook.
Shalev, A., Sahar, T., Freedman, S., Peri, T., Click, N., Brandes, D., Orr, S., & Pitman, R. (1998).

    Predicting PTSD in Trauma Survivors: Prospective Evaluation of Self-Report and Clinician-

    Administered Instruments. British Journal of Psychiatry, 170, 558-564.
Smyth, L. (1999). Cognitive-Behavioral Treatment of Anxiety Disorders. Havre De Grace, MD: RTR

    Publishing Company.

Erwin R. Parson, Ph.D., A.B.P.P. is a Diplomate in Psychology, Master Clinician and Trauma Treatment Technology Developer with over 20 years experience. Dr. R. Parson is a member of Gift From Within's Board of Directors.

Having worked in the area of administration of trauma programs in the past, Dr. Parson's full time employment is in direct treatment of trauma adult and child victims. He is author of dozens of articles and book chapters in the area of trauma, ethnicity, and healing. He his currently writing a book he hopes to facilitate the healing process for victims of September 11^th .