Editor’s note: Elaina Zachos is a science journalist and lead writer for the grant consultancy Overstories, which helps environmental nonprofits secure grant funding to sustain belonging in their communities. She was previously the assistant WUI coordinator for Utah DNR’s Southeast Area, which is how she learned about FAC Net’s work. Elaina has worked in wildfire mitigation, hurricane recovery, and tornado and flood response across the country as a disaster field specialist. She is also a researcher and contributor to National Geographic. As a guest author for this blog, Elaina explains research on trauma-informed care in the aftermath of catastrophic wildfires. She speaks with Dr. Adrienne Heinz, a psychologist at the VA National Center for Posttraumatic Stress Disorder and Stanford University, about her team’s study on the effects of yoga, a custom mobile app, and a disaster mental health intervention with survivors of the 2017 Northern California firestorms. The post also includes recommendations on trauma-informed resources for wildland firefighters.
People are resilient in the face of destruction from hazards, like wildfires. But health problems triggered by stress and trauma can develop if communities don’t have the resources to respond.
Wildland firefighters regularly interact with these types of incidents for work. They have an increased risk for depression, alcohol use, sleep deprivation, and post-traumatic stress. Each year, more first responders die by suicide than in the line of duty.
In October 2017, Sonoma County and other communities in northern California were impacted by more than a dozen historic wildfires. To combat mental health impacts from the fires, community partners formed a mental health collaborative to bring trauma-informed care to survivors. Called the Sonoma Wildfire Mental Health Collaborative, the group deployed and evaluated three strategies for care: one with yoga, one involving a mobile app, and one using an intervention called Skills for Psychological Recovery.
What is Trauma-Informed Care?
A trauma-informed approach works off a holistic view of mental health care. It shifts the narrative from a snapshot of a person’s life to a complete picture of their personal experiences. Trauma-informed care for wildland firefighters would include examining their job and life experience in the midst of a wildfire, rather than only looking at their reaction to one fire.
This approach also values people’s experiences with vicarious trauma and compassion fatigue. It aims to combine trauma-informed knowledge with policies, procedures, and practices, and to actively avoid re-traumatizing survivors.
Sonoma County, CA.
Trauma and stress affect more than just the way we think. They are stored in the body and can lead to muscle pain, irritability, trouble sleeping, and other interpersonal problems if left untreated.
“There’s also a somatic component of trauma, so there are multiple paths to healing,” says psychologist Dr. Adrienne Heinz, who helped form the collaborative.
She adds some individuals benefit more from community support, some prefer evidence-based treatment and therapy, and some get the most from spending time in nature and staying active.
“There’s not one size that fits all,” Dr. Heinz says. “It’s [about] helping individuals become informed consumers of the mental health resources that are available.”
Origins of the Collaborative
Following the destruction of the northern California firestorms in 2017, psychologists and local health practitioners saw a need for a long-term mental health program to supplement FEMA efforts. Making use of relationships that existed before the fires, the nonprofit Healthcare Foundation Northern Sonoma County partnered with philanthropic and community stakeholders to create the Sonoma Wildfire Mental Health Collaborative.
“We’re very resilient and can bounce back from a lot. But at the same time, you can’t endure this alone,” says Dr. Heinz. “You need the support of communities and institutions to overcome [trauma].”
The collaborative sought to make evidence-based mental health resources more accessible, increase community resiliency, and inform future disaster response by measuring the effectiveness of certain approaches to trauma.
Trauma-Informed Techniques
Yoga
Yoga is a well-received, holistic approach to dealing with trauma. A trauma-informed practice helps survivors become more aware of their bodies, with intentional breathing, chanting, and calming postures. Instructors can offer variations to suit individual comfort levels.
“Essentially, you’re shifting out of fight-or-flight to rest-and-digest,” said Dr. Heinz in a keynote address.
For the collaborative’s yoga program, the Healthcare Foundation paid 60 instructors to complete specialized trauma-informed training. Local studios donated space for 160 classes, which were free to the community. The classes involved diaphragmatic breathing to encourage deep breathing, chanting to release the tense vagus nerve, and restful and restorative postures.
The classes served over 2,000 survivors. Eighty-five percent said they felt better at the end of the class, and more than half said they had attended more than one class.
Mobile app
Between suffering from grief and loss, dealing with insurance companies, and juggling everyday responsibilities, disaster survivors have incredibly busy lives. Among other things, firefighters also have chaos from erratic schedules in responding to wildfires.
Public health apps are equitable because they’re scalable and accessible, Dr. Heinz says. They can increase the reach of care and resources to people who normally would not have the time or money to access them. “Having an app reduces the stigma around help-seeking,” she adds. “You can do it in the privacy of your own home at a pace that works for you.”
“Having an app reduces the stigma around help-seeking,” says Dr. Heinz.
The collaborative’s app, called Sonoma Rises, was for everyone impacted by wildfires. It was intended to help survivors find a new normal, build resilience, and improve their well-being. Free, convenient, and easy to use, it was available in English and Spanish, and the Spanish version was reviewed for cultural competence. Sonoma Rises also didn’t require users to input identifying information to use the app.
The app was evidence-informed, audio-guided, and interactive, with self-paced content sections to help users cope with stress, manage anger, heal from loss, prioritize self-care, and reconnect with others. It also had features to track mood, access psycho-education resources, and directly connect with free and local mental health care services.
The public version of the app was downloaded by 1,058 people, who used it for about three minutes and 22 seconds per day. Although it was engineered with wildfires in mind, the app could also be useful for individuals recovering from other hazards.
Unfortunately, Sonoma Rises ran out of funding in June 2020 and is no longer available for download. But Dr. Heinz, who is also a research scientist at the National Center for PTSD, says there’s another option with similar components.
“PTSD Coach would be very helpful as a starting place for wildland firefighters,” she says, referring to an app designed to help people manage symptoms after traumatic experiences. “It’s for anyone.”
Skills for Psychological Recovery
The collaborative’s third strategy was counselor training on Skills for Psychological Recovery. Developed by the National Child Traumatic Stress Network, this intervention is intended to be used in the months and years following a disaster. It helps survivors identify their needs and concerns and provides evidence-based coping skills so they can be more productive after experiencing trauma.
SPR gathers information and prioritizes survivor assistance, builds problem-solving skills, rebuilds healthy social connections, promotes positive activities and helpful thinking, and manages trauma and stress reactions. It can be delivered to survivors by non-licensed paraprofessionals, so it can train providers on a large scale.
The collaborative’s training included five two-day workshops, a group phone consultation, and a moderated Facebook group. More than 400 therapists and paraprofessionals were trained and then offered free therapy to the community. Overall, the counselors found SPR to be practical and flexible in supporting individuals after wildfires.
Recommendations for the Future
According to papers released by the Collaborative, mental health and wellness offerings should be marketed intensively after disasters. Community members, leaders, and officials must also speak openly about the importance of personal well-being.
Recovery can take years, and organizations need to implement sustainable public mental health programs following these incidents. Or ideally, before them. These organizations and governments need more funding from in-kind donations, sponsorships, fundraising efforts, and grant funds. Communities can be better prepared by planning for supportive programming before a wildfire.
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