Question 1

Occupational therapy first got involved in disaster response after what major historical event?

Accepted Answer

Occupational therapy practitioners became particularly interested in disaster response and recovery following the terrorist attacks on September 11, 2001. In 2006, the American Occupational Therapy Association (AOTA) published its first official document on the role of occupational therapy in disaster preparedness, response, and recovery (DPRR). The document was revised (2011) and replaced with the Societal Statement on Disaster Response and Risk Reduction (2017). In the third edition of the Occupational Therapy Practice Framework, the definition of clients was modified to include persons, groups, and populations (AOTA, 2014). This concept of client better aligns with the role of occupational therapy practitioners in supporting communities, not just individuals, after traumatic events.

Question 2

An example of a natural disaster is a:

Accepted Answer

How much influence humankind has had on the number or severity of natural disasters is being debated, but there has been a gradual increase in natural disasters such as hurricanes, earthquakes, floods, and wildfires in the United States, from 60 recorded events in 1980 to 100 in 2016 (Insurance Information Institute [III], 2019b). Of the 10 most costly hurricanes on record, three occurred in 2017: Harvey, Irma, and Maria (Weather Channel, 2018). Over 90% of wildfires can be attributed to humans. It is predicted that more of the worst type of wildfires with large, destructive blazes will spread secondary to rising temperatures (III, 2018). Warmer temperatures increase the probability of wildfires by causing drier vegetation, more lightning strikes, a longer fire season, and intense winds. In 2017, over 14 million dollars in losses were estimated due to wildfires, heat waves, and drought (III, 2018). Residents of the affected areas may be displaced temporarily or permanently.

Question 3

Which of following disasters may not allow for participating in the first stage of a disaster, disaster planning and preparedness?

Accepted Answer

Disasters progress through three main stages, and different behavioral and organizational responses are needed for each stage. The first stage, disaster planning and preparedness, has two phases. The first phase, planning, occurs well in advance of a disaster and provides an opportunity for developing disaster response plans. The second phase-preparation, or the immediate pre-impact period-occurs in the hours or days preceding the disaster and provides an opportunity for disaster preparation if time permits-for example, obtaining supplies in anticipation of a hurricane. In some cases, such as a school shooting or an earthquake, there may be no warning, and therefore no ability to prepare.

Question 4

An all-hazards approach seeks to ensure the community has the capacity to address a broad range of emergencies through maintaining certain core functions that will be needed in most disasters, including:

Accepted Answer

The all-hazards approach focuses on developing the generic capabilities that are critical to prepare for and respond to a full spectrum of emergencies and disasters: natural (e.g., hurricane), technological (e.g., oil spill), and intentional (e.g., terrorist bombing). This approach takes into consideration the population's vulnerability to specific hazards but does not specifically address every possible threat. Rather, an all-hazards approach seeks to ensure the community has the capacity to address a broad range of emergencies through maintaining certain core functions that will be needed in most disasters. These core functions include communication, evacuation, and shelter. Emergency plans need to be sufficiently flexible and scalable to adapt to not only the anticipated risks, but also to the unexpected (Canton, 2013).

Question 5

Which of the following governmental agencies plays a significant role in disaster preparedness, recovery, and response?

Accepted Answer

Although almost every federal agency has some role in DPRR, the governmental agencies with the majority of responsibility described here include the following:
• U.S. Department of Homeland Security (USDHS)
• Federal Emergency Management Agency (FEMA)
• U.S. Department of Health and Human Services (USDHHS), Office of Preparedness and Response (OPR)
• U.S. Public Health Service (USPHS)
• State- and Local-Level Emergency Management Agencies (EMAs)

Question 6

An effective strategy for managing disaster response identified by the National Response Framework is/are:

Accepted Answer

The National Response Framework (NRF) developed by FEMA outlines principles, roles and responsibilities, and best practices for managing emergencies and disasters, ranging from serious, small-scale local incidents to large-scale disasters. The principles underlying the NRF include: "(1) engaged partnership, (2) tiered response, (3) scalable, flexible, and adaptable operational capabilities, (4) unity of effort through unified command, and (5) readiness to act" (USDHS, 2013, p. 5). The construct of Emergency Support Functions (ESFs) has proven to be an effective strategy for managing disaster-related resources. The ESFs group the coordinating agencies, resources, and capabilities into the functional areas frequently needed in disaster response. Federal ESF agencies and departments may be selectively activated depending on the nature and scope of the disaster. The NRF lists 15 ESFs (see Table 26-1) (USDHS, 2013). ESFs #6 and 8 are of most interest to occupational therapy practitioners.

Question 7

Which of the following aspects of the Emergency Response Functions (ESFs) is most appropriate for occupational therapy?

Accepted Answer

The National Response Framework (NRF) developed by FEMA outlines principles, roles and responsibilities, and best practices for managing emergencies and disasters, ranging from serious, small-scale local incidents to large-scale disasters. The principles underlying the NRF include: "(1) engaged partnership, (2) tiered response, (3) scalable, flexible, and adaptable operational capabilities, (4) unity of effort through unified command, and (5) readiness to act" (USDHS, 2013, p. 5). The construct of Emergency Support Functions (ESFs) has proven to be an effective strategy for managing disaster-related resources. The ESFs group the coordinating agencies, resources, and capabilities into the functional areas frequently needed in disaster response. Federal ESF agencies and departments may be selectively activated depending on the nature and scope of the disaster. The NRF lists 15 ESFs (see Table 26-1) (USDHS, 2013). ESFs #6 and 8 are of most interest to occupational therapy practitioners.

Question 8

Occupational therapy personnel are most likely interested in participating in which aspect of FEMA response?

Accepted Answer

FEMA has two initiatives that are of particular interest to occupational therapy practitioners: Community Emergency Response Teams (CERTs) and the Emergency Management Institute. CERTs train volunteers to prepare for and respond safely and effectively to the specific types of disasters their communities are likely to experience. There are over 2,700 local CERT programs across the country. Occupational therapy personnel are eligible to participate in CERTs. The CERT training includes the following topics:
• Disaster preparedness,
• Fire suppression,
• Medical operations,
• Light search-and-rescue operations,
• Psychology and team organization, and
• Course review and disaster simulation.

Question 9

Under which agency have occupational therapists been deployed to provide disaster support in a facility for older adults with special needs?

Accepted Answer

The USPHS workforce, including occupational therapists, can be mobilized and deployed during disasters or other public health emergencies. USPHS occupational therapists have served on disaster mental health teams under the auspices of FEMA and the American Red Cross (ARC) during a number of natural disasters, including Hurricane Katrina in 2005 and other hurricanes in Florida. For example, occupational therapists were deployed to a very large emergency shelter for older adults with special needs in Florida, and to a National Guard unit in Mississippi to assist "first responders, caregivers, and service providers, many of whom had witnessed trauma or were victims of loss themselves" (Oakley, Caswell, & Parks, 2008, p. 363).

Question 10

Which of the following is a community-based organization that assists with disaster response?

Accepted Answer

Although there are hundreds of community-based organizations that respond to disasters, the most active and visible in emergency situations are the ARC and the Salvation Army (SA). Other lesser-known non-profit organizations described here include:
• National Voluntary Organizations Active in Disaster
• International Critical Incident Stress Foundation
• Humane Society of the United States

Question 11

In a disaster, occupational engagement is not just disrupted for individuals and families but also for the:

Accepted Answer

Disasters not only have an impact on individuals. They "impact whole communities, resulting in potential community-wide economic, environmental, governmental, social and cultural disruptions" (Smith & Scaffa, 2014, p. 965). In the same way that performance patterns of individuals are interrupted by disaster, the roles and routines in the community are also are impacted. The roles and routines of community agencies, worksites, and places of worship must also adapt to address the challenges presented by disasters. The destruction of schools and worksites due to a disaster may make it challenging or impossible to participate in education and work-related occupations. Social participation and co-occupations with family, friends, and neighbors may be affected by widespread evacuations.

Question 12

Sara is a 38-year-old woman whose home was lost in a wildfire 2 months ago. She reports feeling anxiety and is not sleeping well due to frightening dreams. She is most likely experiencing:

Accepted Answer

The emotional impact of disaster can sometimes be more devastating than the loss of home and personal property and often lasts longer than the physical manifestations (Carroll, Morbey, Balogh, & Araoz, 2008). Typical emotional reactions to acute stress include fear, anger, depression, anxiety, grief, confusion, helplessness, hopelessness, and emotional numbing. These "traumatic stress reactions are normal reactions to abnormal circumstances" (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014. p. 59). If the emotional reactions are severe, these feelings can interfere with occupational performance, especially sleep, and cognitive functions such as decision-making and concentration. Children, older adults, and persons with physical and mental health challenges are especially at risk. If symptoms persist for more than 1 month and cause distress and/or impair social or work functioning, then a person may be diagnosed with posttraumatic stress disorder (PTSD). The mental health impact of a disaster is a function of proximity, intensity, and duration. The greater the intensity, the longer the duration, and the closer the proximity of the disaster, the more likely a person is to experience mental health problems (Hobfoll & De Vries, 2013).

Question 13

A protective factor against the development of mental health problems post-disaster is:

Accepted Answer

Considerable evidence identifies social support as a protective factor against the development of mental health problems post-disaster (Neria, Besser, Kiper, & Westphal, 2010; Ozer, Best, Lipsey, & Weiss, 2003). Social support can come from individuals and the community. The community provides a sense of belonging and can offer communal coping in the event of shared traumatic experiences (Houston, First, & Danforth, 2018) or a sense of shared responsibility in response to disasters. Communities can exist in many forms, such as neighborhoods, cities, schools, workplaces, churches, professional associations, and virtual support groups.

Question 14

Psychological first aid (PFA) is designed to reduce the initial distress experienced with trauma and to facilitate positive adaptive functioning in the short and long term. An essential element of PFA is:

Accepted Answer

Psychological first aid (PFA) is designed to reduce the initial distress experienced with trauma and to facilitate positive adaptive functioning in the short and long term. PFA is appropriate for all age groups and developmental levels. It is flexible and applicable in a variety of disaster situations. There are five essential elements to PFA: (a) providing a sense of safety, (b) promoting calming, (c) fostering a sense of self- and community efficacy, (d) encouraging connectedness, and (e) instilling hope (Hobfoll et al., 2007). Trained volunteers offer PFA immediately post-disaster (usually within 48 hours) after the basic needs for food, shelter, and safety are met, and while people are working to reestablish their daily routines. It provides information, comfort, and practical support tailored to the needs of individual survivors (SAMHSA, 2014).

Question 15

After losing their farm to a flood, Mr. and Mrs. Gregory report feeling their relationship has improved and they have more excitement for the next phase of life. Mr. and Mrs. Gregory are experiencing the post-disaster phenomena of:

Accepted Answer

Resilience is the ability to return to baseline functioning after trauma. In addition to facilitating resilience, mental health intervention post-disaster can foster posttraumatic growth (PTG), improvement beyond pre-trauma adaptation that can sometimes be deeply profound (Tedeschi & Calhoun, 2004).
PTG is a "positive psychological change experienced as the result of the struggle with highly challenging life circumstances" (Tedeschi & Calhoun, 2004, p. 1). The cognitive and emotional "struggle [emphasis added] with the new reality in the aftermath of trauma" (italics added, p. 5) is crucial for PTG to occur. The five domains in which positive changes typically take place in the PTG process include:
• "Greater appreciation of life and a changed sense of priorities,"
• "Greater sense of personal strength" and capabilities,
• Deeper, more meaningful relationships with others,
• "Recognition of new possibilities or paths for one's life," and
• Richer spiritual life and/or renewal (Rollins, 2012, para. 9).
Three factors appear to facilitate PTG:
1. The individual personality characteristics of extraversion, positive affect, optimism, ability to manage distressing emotions, and openness to experience,
2. The degree to which a person discloses their feelings and perceptions of the traumatic event (tells their story) and the social support the person receives in response to that disclosure, and
3. Cognitive processing of the event/trauma in which resolving discrepancy and developing new life schemas are the outcomes (Tedeschi & Calhoun, 2004).

Question 16

An evidence-based model for addressing community and population mental health needs in disaster recovery is the:

Accepted Answer

An occupational therapy approach to addressing mental health needs post-disaster and facilitating PTG is the use of the Recovery Model outlined by SAMHSA (Pizzi, 2015). The Recovery Model consists of 10 components: self-directed, individualized and client-centered, empowerment, holistic, nonlinear, strengths-based, peer support, respect, responsibility, and hope. The Recovery Model can be used as a frame of reference for community- and population-based occupational therapy intervention in disaster recovery. Based on research of survivors' reactions to Hurricane Sandy, Pizzi (2015) identified potential occupational therapy interventions for each of the 10 components.

Question 17

Which subset of older adults is especially vulnerable during a disaster?

Accepted Answer

Older adults, particularly those who are homebound, are at high risk. The number of older adults is increasing with the aging of the baby boomers, yet little attention is being given to disaster resilience for older adults (Shih et al., 2018). Occupational therapy practitioners can not only help individuals prepare for disasters in at-risk areas, but also work in coordination with public health departments and age-friendly communities to add disaster preparation to aging-in-place plans

Question 18

Which group of people is vulnerable during a disaster but is not included in the FEMA definition of special-needs populations?

Accepted Answer

Others who are vulnerable, but not included in the FEMA definition of special-needs populations, are the disaster relief workers. Disaster relief workers, both volunteer and professional, are usually the first on the scene of a disaster and may witness a variety of traumatic events (Lanza, Roysircar, & Rodgers, 2018). They work long hours under difficult conditions and are frequently expected to engage in tasks that could potentially result in injury or even death. Even though the emergency management system has procedures in place for debriefing professional first responders following traumatic events, approximately 30% develop mental health problems such as depression and PTSD, as compared with 20% in the general population (Abbott et al., 2015). First responders are at high risk for vicarious traumatization, compassion fatigue, and burnout. Each disaster situation is different, and as a result the needs of disaster relief workers and volunteers will vary from disaster to disaster. For this reason, Lanza et al. (2018) recommend psychoeducation for responder self-care to maintain resilience prior to deployment to the area, immediately after the trauma exposure, and long-term, if, necessary. Self-care areas upon which to focus are "self-reflection journaling, eating well, prioritizing sleep and rest, expressing emotions, attending to family relationships, connecting with friends and one's community, embracing religion or spirituality, engaging in cognitive activities, and attending to financial and physical security" (Lanza et al., 2018, p. 196).

Question 19

One setting where occupational therapists can help with disaster planning for children with special needs is:

Accepted Answer

Schools often are often the most likely place that children will be when a disaster occurs. School disaster planning is essential and typically consists of identifying school crisis teams, delineating the roles of staff during an emergency, and establishing processes for reuniting children with their parents. Occupational therapy practitioners who work in academic settings (e.g., grades K through 12 schools, universities) can assist in school planning regarding the requirements of students with special needs (AOTA, 2011).

Question 20

Occupational therapy practitioners are especially qualified to provide disaster response services for which population?

Accepted Answer

Occupational therapy practitioners are especially qualified to provide disaster response services for people with special needs. These include persons with physical, mental, or medical-care needs who may require assistance before, during, or after a disaster when they have exhausted their usual resources and support systems. People with special needs may be evacuated to general public shelters or shelters for people with special needs, or they may shelter-in-place (i.e., remain in their personal homes, assisted living facilities, foster and group homes, or long-term care facilities). Occupational therapy expertise is useful in all these settings and situations (AOTA, 2011).

Quiz 26: Disaster Preparedness, Response, and Recovery Introduction