A Quarterly Technical Assistance Journal on Disaster Behavioral Health

Produced by the SAMHSA Disaster Technical Assistance Center

The Dialogue 

2023 | VOLUME 18 | ISSUE 1–2

Mass Violence, Community Violence, and Hate Crimes
 

 

 

 

CONTENTS

3 In This Issue

4 Contributors

7 Technical Assistance Snapshot

8 A First Responder’s Perspective on Mass Violence Response

13 Community Violence and Healing: 

Overcoming Trauma and Instilling Hope

16 Bringing More Voices to the Table(top): Planning for Effective Response to Incidents 

of Violence 

21 Telling Every Story: Building Narratives as a Community After Hate-based Mass Violence

26 Disaster Preparedness and Recovery in the Context of Community Violence: Recognizing 

and Repairing Fragile Relationships To Minimize Harm

28 Supporting Resiliency in Communities Affected by Violence: Responding to Incidents in 

the United States and Around the World

32 Recent Technical Assistance Requests

COVER Photo by Melissa Riley

The Dialogue is a quarterly technical assistance journal on disaster behavioral health which 

is produced by the Substance Abuse and Mental Health Services Administration (SAMHSA)

Disaster Technical Assistance Center (DTAC). Through the pages of The Dialogue, disaster 

behavioral health professionals share information and resources while examining the 

disaster behavioral health preparedness and response issues that are important to the field. 

The Dialogue also provides a comprehensive look at the disaster training and technical 

assistance services SAMHSA DTAC provides to prepare states, territories, tribes, and local 

entities so they can deliver an effective disaster behavioral health response. 

SAMHSA DTAC provides disaster technical assistance, training, consultation, resources, 

information exchange, and knowledge brokering to help disaster behavioral health 

professionals plan for and respond effectively to mental health and substance misuse needs 

following a disaster.

To learn more or receive The Dialogue, please call 1–800–308–3515, email dtac@samhsa.

hhs.gov, or visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac.

The Dialogue is not responsible for the information provided by any web pages, materials, or organizations referenced in this publication. Although 

The Dialogue includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services 

provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such 

sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose.
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

In This Issue

Community and mass violence and hate crimes not only

take lives but leave a lasting trauma legacy. Exposure to

mass violence, such as mass shootings in public places,

affects a relatively small number of individuals directly,

but the whole community and, in some ways, the whole

country may experience behavioral health impacts.

Community violence, such as ongoing violence in areas

experiencing high rates of poverty, also has undeniable

behavioral health impacts, along with other stressors

associated with living in poverty and experiencing

structural disadvantage. Youth and young adults are

especially vulnerable to these incidents of violence,

and communities experiencing high rates of poverty

and racial segregation may also be disproportionately

affected. The subset of community and mass violence

incidents that are hate crimes have their own potent

effects, as people both near and far to the incident who

share an aspect of identity targeted in the hate crime

may feel more vulnerable. As the frequency of violent

incidents increases in the United States, these mental

health impacts affect larger swaths of the population.

Community and mass violence have become behavioral

health crises.

Violence in our neighborhoods, schools, and places of

business is not something that only affects populations

Memorials to victims outside the Tree of Life synagogue. Official White House

photo by Andrea Hanks.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 3

A gathering after a violent incident can help restore a sense of community.

Adobe Stock photo.

in the short term. The trauma of community or mass

violence can create ongoing negative effects for the

victims, their families, and entire communities. While

intervention strategies are essential in the effort to

reduce future occurrences, resilience is the tool needed

to counteract the negative impacts of violence, both

on the individual and community levels. Building

resilience is critical, and something communities and

individuals can pursue as they plan and prepare, not only

in response to an event. Understanding and preparing for

threats is one of the ways to ensure more resilience, thus

preventing persistent trauma that can affect a population

for years, or even generations.

In this issue of The Dialogue, we gather a variety of

experts to bring their unique perspectives on these

complex topics. In the first article, a first responder

recounts the aftermath of a mass violence event

and its impact on those responding. Next, an expert

discusses the effects of community violence, as well

as prevention and intervention strategies. The third

feature is an interview with two staff members of

the Improving Community Preparedness to Assist

Victims of Mass Violence and Domestic Terrorism:

Training and Technical Assistance (ICP TTA) Program,

which is focused on partnership and planning steps

communities can take before violence occurs. In the

fourth article, a leader in the response to the October 27,
 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

2018, synagogue shooting in Pittsburgh, Pennsylvania,

describes how her community has coped with a hate

crime and grown stronger through collective processes

of healing. In the following article an expert weighs in

on the impacts of natural or human-caused disasters in

communities that experience high rates of community

and structural violence. The final article explores the

topic beyond the United States and examines the effects

of community violence on children. The issue also

features a poster readers can print and post that provides

an overview of the topic of hate crimes and steps

communities can take to cope, enhance resilience, and

recover.

Have you been part of preparedness, response, or

recovery efforts focused on community or mass violence

or hate crimes? Other planners and responders can learn

from your efforts and experience. Please contact us to

share your stories and lessons learned. ■

CAPT Erik Hierholzer, B.S.N. Program Management

Officer, Emergency Mental Health and Traumatic Stress

Services Branch

erik.hierholzer@samhsa.hhs.gov

Nikki Bellamy, Ph.D. Public Health Advisor,

Emergency Mental Health and Traumatic Stress

Services Branch

nikki.bellamy@samhsa.hhs.gov

Shannon Loomis, M.A. Director, Substance Abuse and

Mental Health Services Administration (SAMHSA)

Disaster Technical Assistance Center (DTAC)

dtac@samhsa.hhs.gov

Contributors

Patricia Campie, Ph.D., is

a Principal Researcher at

the American Institutes for

Research. Utilizing more

than 25 years of experience,

Campie’s primary research

focus is on preventing and

reducing lethal violence among youth and young adults

in the United States and other countries. She serves as a

core member of the global Armed Conflict and Violence

Prevention Research Advisory Group for the United

States Agency for International Development’s Center

for Conflict and Violence Prevention and has coauthored

studies on gang desistance in the Northern Triangle,

youth violence in Colombia, and a global evidence

review of what works to prevent lethal communitybased violence. In the United States, Campie has

been evaluating, since 2013, Massachusetts’ Safe

and Successful Youth Initiative, a statewide violence

prevention initiative that targets high-impact gun- and

gang-involved males and females (17–24 years) at

risk for violence in 14 cities, an intervention that has

produced sustained reductions in gun violence over

more than 9 years, even when other cities have seen

violence spike in post-pandemic times. Campie also

leads a longitudinal study on the root causes of school

and community violence in California and is evaluating

the Community Crisis Intervention Program in

Philadelphia, patterned after the Cure Violence model.

Amanda Eagan, M.A.Ed.,

serves as Senior Training

and Technical Assistance

Specialist with the ICP TTA

at ICF, Inc. She comes to the

ICP TTA team after 7 years

of working in the higher

education sector at Virginia Tech. During this time,

Eagan supported the learning and development of

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 4
 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

students, faculty, and staff through the creation and

delivery of learning opportunities of various formats,

including a continuous learning series, written materials,

multiday leadership trainings, seminar courses, and a

peer education program. At the start of the COVID-19

pandemic, Eagan was appointed to coordinate Virginia

Tech’s response for the 10,000-student residential

population. In this role, she worked with campus and

community partners to develop and execute new policies

and procedures to promote the health and safety of the

university community at large. In addition to organizing

the depopulation and repopulation of campus, Eagan

created and directed the university’s isolation and

quarantine procedures in coordination with university

and district health officials. Additionally, Eagan

oversaw the evaluation and adjustment of departmental

standard operating procedures in alignment with

health guidelines. She also developed both internal and

external communication streams to keep residential

staff, students, and families informed of university

decisions related to COVID-19. Eagan received her B.S.

in emergency management from Saint Louis University

and her M.A.Ed. in higher education and student affairs

from Virginia Tech.

Maggie Feinstein, M.A., LPC,

is the Founding and Executive

Director of the 10.27 Healing

Partnership. She is a master’s

level professional counselor

who has distinguished herself

in the field of integrated mental

health. She received her undergraduate degree at the

University of Wisconsin-Madison in international

relations and received her master’s degree from the

University of San Francisco in counseling psychology.

She worked in San Francisco and Anchorage before

returning to Pittsburgh. She currently resides in Squirrel

Hill with her husband and two children.

Tara S. Hughes, LCSW-R, is the

Project Director for ICP TTA at

ICF, Inc. The ICP TTA Program

delivers training and technical

assistance to local, state,

regional, and tribal jurisdictions

across the country, including

U.S. territories, to augment existing emergency response

plans to ensure effective protocols and strategies

to address the immediate and long-term needs of

victims, families, and first responders after incidents

of criminal mass violence and domestic terrorism.

Hughes is a subject matter expert in mass violence

response, working directly with victims and families

to ensure comprehensive care. She oversees work with

communities to plan for mass violence response. She

has extensive experience working in mass violence/

casualty incidents, with a focus on violence that impacts

large numbers of people and whole communities.

Hughes uses her experience in trauma counseling and

crisis response to ensure compassionate and effective

care of people impacted by incidents. Her immediate

response history encompasses a wide variety of

incidents, including the crash of Colgan Air Flight 3407;

the 2010 Haitian earthquake; the Newtown, Connecticut,

Sandy Hook Elementary School shooting; Boston

Marathon bombing; Orlando Pulse nightclub shooting;

and October 1, 2017, Route 91 Harvest Festival shooting

in Las Vegas. Her long-term recovery work includes

the Pittsburgh synagogue shooting; Virginia Beach

municipal workplace shooting; and Gilroy, California,

Garlic Festival shooting. Hughes received her B.A. in

psychology from Boston College and master of social

work (M.S.W.) and family therapy certification from

Boston University. Her clinical practice has focused on

treatment of survivors of trauma, with a concentration

on crisis/trauma response and family interventions. She

has extensive experience working in communities where

violence is the norm and has responded to a variety of

communitywide traumatic events.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 5
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Robert D. Macy, Ph.D., DMT, is

trained as a theatre artist, Taoist

martial artist, dance movement

therapist, developmental

traumatologist, and disaster

behavioral health manager.

He has developed body-based

psychological trauma interventions and has launched the

design, development, dissemination, and implementation

of trauma-informed care assessment and intervention

service delivery systems in the United States and

overseas focusing on schools, residential treatment

centers, inpatient units, communities of color with highpriority populations, emergency services, and largescale community engagement. Macy is the Founder and

President of the International Trauma Center-Boston,

and Co-Founder and Executive Director of The Boston

Children’s Foundation. Macy is a founding member of

the National Child Traumatic Stress Network (NCTSN),

where he is a primary content provider and National

Master Trainer for the development of Psychological

First Aid, and primary content provider and National

Master Trainer for Skills for Psychological Recovery.

He has co-chaired the NCTSN Terrorism and Disaster

Network Committee and continues as a senior consultant

to the NCTSN Terrorism and Disaster Center and has

led numerous response and behavioral health recovery

teams during national and international disasters. A

senior response member for SAMHSA DTAC, Macy

is activated by DTAC for major terrorist attacks and

natural disasters in the United States providing Crisis

Counseling Assistance and Training Programs (CCPs)

and continuum of care trauma-focused interventions for

youth, family, and community. Macy was 1 of only 12

experts in the nation to be selected to membership for

the Barack Obama-commissioned Attorney General’s

Federal Advisory Commission on Children Exposed

to Violence as part of Attorney General Eric Holder’s

Defending Childhood Initiative. Macy designs,

implements, and evaluates trauma-focused psychosocial

resiliency initiatives, violence prevention programs, and

trauma-informed care initiatives in the United States,

Europe, the Middle East, Eurasia, and Africa.

Melissa Riley, Ph.D., AEMT,

CFI, is currently an Assistant

Professor in the Department

of Applied and Industrial

Technologies in the College

of Engineering at Tennessee

State University. She is from

Nashville, Tennessee, and has worked in emergency

services for 30 years. She is a certified firefighter,

advanced emergency medical technician (EMT),

wilderness EMT, police officer, hostage negotiator,

handgun and rifle instructor, search and rescue K9

handler, and public safety rescue/recovery diver.

She currently teaches aerospace at Tennessee State

University and has over 2,200 flight hours with over

1,500 as a flight instructor. Riley is a national trainer

for SAMHSA for the disaster behavioral health grants

where she has 12 years’ experience working in the

disaster behavioral health field. Prior to that she also

worked as a crisis counselor for behavioral health in

Middle Tennessee. She has worked for SAMHSA DTAC

to help create courses for first responders related to

depression, posttraumatic stress disorder, and suicide.

Ciara Suros, LCAS, LCSWA,

CSI, is a licensed addiction

and mental health clinician

in North Carolina. She is a

Regional Director for Covenants

Sandhills Region. She is a

veteran of the U.S. Army

and, shortly after medical retirement, she pursued her

education in social work. She currently holds a master

of social work degree from Fordham University. She

obtained her clinical license in addiction and social

work to aid the populations she serves. Suros has a

growing family with a husband and children that she

loves dearly. Suros remains engaged and active in the

community, where she volunteers and advocates for atrisk populations.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 6
 

 

 

 

 

 

 

 

 

 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

TECHNICAL ASSISTANCE SNAPSHOT

Requests Received by SAMHSA DTAC for

TA Related to Violence, 

2017–2022

Number of Requests by Year Number of Requests by Type

2017 6 Mass Violence

2018

2019

2020

2021

3

4

6

8

School Violence

Terrorism

27

3

6

2022 9

Most requests to SAMHSA DTAC for technical assistance (TA) during this period were for incident types other 

than mass violence, school violence, or terrorism. From 2017 through 2022, there were 2,026 requests to 

SAMHSA DTAC for TA, and only 36, or about 1.8 percent, were related to violence.

Are you looking for disaster behavioral health resources?

Check out the new and updated

SAMHSA DTAC Disaster Behavioral Health Information Series (DBHIS) installments.

https://www.samhsa.gov/resource-search/dbhis

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 7
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

A First Responder’s Perspective on Mass 

Violence Response

By Melissa Riley, Ph.D., AEMT, CFI, Tennessee State University

Responders survey an area of Nashville bombed in December 2020. Photo by Melissa Riley.

On Christmas morning, December

25, 2020, there was a report of

shots fired in the historic district

in downtown Nashville. Then an

RV was discovered parked in the

district, and it began playing music

over a loudspeaker—“Downtown,”

by Petula Clark—with breaks in the

music to announce that a bomb was

going to explode. Six on-duty metro

police officers responded and risked

their lives going door to door and

evacuating residents, not knowing

when or if a bomb would explode.

Eventually the RV’s driver detonated

the explosives that filled the vehicle

outside of the AT&T building on

2nd Avenue, across from multiple

businesses and apartments, including

Wildhorse Saloon, BBK Blues

Club, Coyote Ugly, Rodizio Grill,

Old Spaghetti Factory, and 34 other

bars and restaurants. The explosion

killed the bomber and injured three

civilians. Multiple videos of the

responding metro police officers’

body-worn cameras released to the

public after the incident revealed

that, as the bomb detonated, each

thought that they had lost a fellow

officer in the explosion and that

they might be killed as well. Many

in the area were knocked down by

the force of the explosion. Some

debris from the bombing was found

embedded into the outside of the

Tennessee Titans Football Stadium.

The explosion was felt by people

over 30 miles away. And all of this

occurred on what is supposed to be

one of the holiest and most joyful

days of the year.

The city of Nashville responded

with police officers, firefighters,

medics, and search and rescue K9s.

Personnel from the Federal Bureau

of Investigation (FBI), Tennessee

Bureau of Investigation (TBI), U.S.

Marshals, and the state medical

examiner also responded. Search

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 8
 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

“

In the midst of mass violence, there is often also bravery, service and 

compassion. Emergency responders rush to the scene. Strangers come 

together to apply first aid and transport victims to hospitals. Doctors and 

nurses work long hours to save lives and give comfort. After the immediate 

crisis has passed, communities may hold vigils or 

events to remember their neighbors and friends

”

(National Center for PTSD, n.d.).

and rescue operations began around then a bigger incident will occur

7:30 a.m. and lasted until 2 p.m. to inflict maximum chaos and

Every apartment, bar, restaurant, confusion. So every first responder

and hotel had to be searched to

make sure no one else was injured

or killed. This meant that hundreds

of apartment and business doors

had to be breached by firefighters,

which was exhausting work done

with the ongoing threat that another

explosion could occur, and that the

damaged buildings could collapse.

Gas leaks and small fires were

present, and debris was continuing

to fall off of buildings and into the

street. After the explosion and for

the duration of search and rescue

operations, fire alarms in the

buildings sounded, making verbal

communication difficult for all

responders.

Every training scenario related to

mass violence since 9/11 teaches

first responders that the first incident

is often used to draw them in, and

working that day knew there

was a high likelihood that there

could be another explosion while

they were conducting search and

rescue operations. In addition, the

temperature outside was 7 degrees

Fahrenheit, so in addition to mental

stress and physical exhaustion, there

was the environmental exposure of

working for long periods outside in

abnormally cold conditions for that

part of the United States.

The community faced long-term

impacts of the bombing—over 1,000

employees of area businesses were

left without jobs, and hundreds were

homeless. For first responders, as

with any incident of mass violence,

the incident was not over in a

moment or two; rather, it would go

on for over a week, and the written

reports and follow-up would last for

months. For the officers present at

the incident that morning, that meant

the added stress of being pulled off

of their regular duties for an endless

array of TV and radio appearances to

talk about their experience. For those

helping to collect evidence, it meant

a week of sifting through Christmas

decorations, children’s toys, parts

of vehicles, parts of bars and

restaurants, broken glass, exploded

brick and metal, and fragmented

body parts. Each piece had to be

photographed and collected from

roadsides, staircases, rooftops, etc.

Experience and Impacts

of Mass Violence on First

Responders

Incidents of mass violence are

unique in that all first responders

train for them, but there is a big

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 9
 

 

 

 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

difference between training for them

and actually having to respond. The

level of intensity for the responders

likely is greater than any call they

have responded to before, due to the

scale and nature of incidents of mass

violence. Responders are also taught

that there is a high risk of injury or

death due to the large-scale nature

of the event and that the event is

often designed to inflict maximum

damage and to injure or kill the

first responders. These events also

draw intense media attention to

the situation. With cameras, news

helicopters flying overhead, and

social media exploding, there is

no way to get relief from being

reminded of the incident without

completing isolating oneself from

TV, social media, radio, and even

other people.

Because the response is often

lengthy to collect the evidence and

account for all human remains,

exposure to some of the worst

sights and smells a first responder

can experience can be drawn out

over multiple days and be very

intense. Long after the initial

adrenaline has worn off, they are

still seeing, smelling, and touching

items that most humans in their

In a review of studies on the 

mental health effects of 

mass shootings, researchers 

found increases in posttraumatic stress symptoms, depression, and 

other psychological symptoms among survivors 

and members of communities where the incidents 

occurred. Risk factors for challenging psychological 

reactions included pre-incident trauma and 

psychological symptoms, higher levels of exposure 

to the incident, difficulties in emotion 

regulation, and low social support 

(Lowe & Galea, 2017).

Images: Mental Health by Victoruler from Noun Project.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 10

entire lifetime will never encounter.

These events can take a very big

emotional toll on first responders

for the myriad reasons spoken

about here. No matter what type of

badge first responders wear, they are

all human beings. In a profession

where over 30 percent will develop

a diagnosable mental illness or

substance use disorder from the

everyday nature of the job, adding in

an incident of mass violence can be

the deciding reason for responders to

leave the profession.

According to Amy Morgan, M.S.C.,

Executive Training Director at

Academy Hour and International

Public Safety Association Mental

Health Committee Member, trauma

from mass violence can create

cyclical patterns of negative thinking

as well as new trauma (Morgan,

2018). Additionally, it can cause

a responder to question the safety

of all situations going forward,

increasing stress and anxiety,

and significantly increasing the

chances of developing depression,

posttraumatic stress disorder

(PTSD), or anxiety disorders.

According to Arash Javanbakht,

Associate Professor of Psychiatry

at Wayne State University, humans

become stressed or terrified when

exposed to a dangerous event,

and when the event is caused by

people, the impact can be profound.

Javanbakht reports that humans

can learn fear and experience terror

through exposure to the trauma and

fear of others, and this can make a

significant impact on the brains of

survivors (Javanbakht, 2021).
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

In a profession that has a

significantly higher rate than the

general population of developing

depression, PTSD, and suicidal

ideation, responding to an act

of mass violence increases the

likelihood of developing these

illnesses, as it is a “flashbulb”

memory event. It will remain with

first responders for the rest of

their lives, similar to other large

events such as 9/11, the space

shuttle tragedies, etc. For some first

responders, especially if they have

been in the field for several years or

more, a mass violence event can be

a “capstone call” for them. It can be

so large and so defining that they do

not feel it will be topped and that

they can retire or change careers

now, feeling like they have given

all of themselves that they can to

that profession. It is difficult to tell

how many first responders leave

the profession after mass violence

incidents as it is a profession where

weakness is frowned upon, so

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 11

Responders search a building after the bombing. Photo by Melissa Riley.

stating that a particular incident was

too much to handle is rarely done.

Instead, in the coming weeks to

months, incidences of retirement or

resignation of positions may occur

without a direct correlation to the

event itself.

Helping First

Responders

Cope With Mass

Violence Events

They key takeaway

from these events is

that it will impact

the responders’

trust in the general

goodness of others.

It will be an event

that imprints on their

mind and that by any

measure is difficult

to understand and

emotionally process. Added to

the ongoing stressors and trauma

exposures of their profession, the

mass violence incident may be

a capstone event that results in

resignation or retirement to prevent

exposure to such trauma ever again.

When agencies in a jurisdiction

respond to such an event, following

up with responders days, weeks,

months, and years later is critical.

While the media and the community

move on, that event will remain

with them. It is important to reach

out and work with them on tips for

developing resiliency, help them

understand that this is a significant

event and how to do more proactive

self-care, potentially develop

first responder-specific support

groups, and touch base with them

around anniversary events or if the
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

perpetrator of the mass violence

goes to trial, as all of these can

be triggers for what they have

experienced, especially if they must

testify in court and relive in public

what they experienced.

While every first responder trains

to respond to an incident of mass

violence, it is rare that they have

to put this training to use. Creating

a proactive network set up for a

long, supportive response is key to

keeping first responders healthy and

helping them to continue using their

skills and talents in the profession

and protecting the areas that they

serve. ■

Responders in Tennessee. Photo by Melissa Riley.

Number of Mass Shootings by Location

Workplace

Retail

Restaurant

Residence

Outdoors

Worship

School

College

Civic

0 10 20 30 40 50 60

31%

17%

14%

8%

8%

7%

7%

5%

4%

52

28

23

14

14

11

11

9

6

Note: The data in this table come from a Voice of America special report (Shahid & Duzor, 2021) on research 

done by The Violence Project, which uses a narrower definition of mass shootings than some other data 

sources and has identified 168 incidents from 1966 to 2020.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 12
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Community Violence and Healing: 

Overcoming Trauma and Instilling Hope

By Ciara Suros, M.S.W., LCAS, LCSWA, Covenants Sandhills Region

The communities people live in

across the country foster some of

the most important experiences in

people’s lives, including friendships,

educational experiences, recreation,

and family traditions. However,

in communities where violence

happens often, the picture is much

more complicated. According to

the Centers for Disease Control

and Prevention (CDC), community

violence is a form of violence

that happens between unrelated

individuals, who may or may not

know each other, generally outside

the home. Examples include assaults

or gun violence in public places,

such as schools and residential areas

(CDC, 2022). In 2020, over 1.4

million people were treated for an

assault in emergency departments,

and nearly 25,000 lost their lives to

homicide (CDC, 2022). Fatalities

are often the most visible impact of

community violence, the one the

public and affected communities

are aware of, but other impacts

of community violence can affect

people over the long term and may

be unrecognized and left untreated.

Many children and adults do not

understand or recognize that they are

suffering from long-term reactions to

trauma. Others may find themselves

receiving treatment or services in

areas where their trauma response

is most visible, such as services for

children in schools to help them

cope with attentional differences that

owe to stress and trauma, or services

for people with substance use

disorders and addictions developed

out of an attempt to cope with the

difficult symptoms of trauma.

Risk Factors

According to the CDC, several

factors place people at greater risk

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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

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of poor health outcomes, including

being exposed to violence. These

factors include experiencing

systemic racism, and the bias and

discrimination associated with it;

living in a household where incomes

are low and access to wealth and

resources is limited; and living

The Centers for 

Disease Control and 

Prevention (CDC) 

defines community 

violence as violence 

that 

“

happens 

between unrelated 

individuals, who 

may or may not 

know each other, 

generally outside 

the home. Examples 

include assaults or 

fights among groups 

and shootings in 

public places, such 

as schools and on 

the streets

(CDC, n.d.).

”

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 14

in a neighborhood where many

people live below the poverty

line. “Communities of color often

disproportionately experience

these negative conditions, placing

residents at greater risk for poor

health outcomes,” the CDC writes.

“For example, Black or African

American, American Indian and

Alaskan Native, and Hispanic or

Latino persons have higher homicide

rates than other racial and ethnic

demographic groups” (CDC, 2022).

As the United States makes efforts

to socially evolve and take more

intentional strides to break down

biases, discrimination, systemic

racism, and other types of inequality

and inequity, there is still more work

to do and more research to conduct

to get a clear understanding of how

to support members of communities

affected by violence in coping

with trauma and reactions to other

adverse experiences, so they can

heal and reach their potential.

If someone is impacted by

the trauma and other adverse

experiences that may be part of

living in a community affected by

violence, that individual typically

suffers in silence. However, that

same individual’s trauma may be

reflected in many areas of their

life. Neighborhoods impacted by

community violence may also

have developed and be served by

programs in areas such as healthcare

services, scholarships, community

services, housing, policing, and

financial needs. The community

services and resources have been

a major help. Nonetheless, they do

not heal the suffering of residents of

these communities who have been

exposed to violence (Teach Trauma,

2022).

Prevention and Intervention

Change agents throughout the

country have a responsibility to

produce and provide effective

services that aid people in

overcoming their barriers. This may

seem like a major responsibility;

however, in ethical guidelines for

many professions, “service” in some

capacity is an obligation (e.g., social

workers, healthcare professionals,

and law enforcement). A large

portion of ethical practice in these

professions is understanding how

social and environmental factors

affect members of the community.

These factors may act as barriers,

keeping community members from

accessing services the professionals

are trying to provide people. For

many community service providers,

there is educational material that

can be shared with their clients or

patients to assist in the prevention

of and intervention in community

violence, and in community

violence reduction or elimination

(CDC, 2022). Great examples of

the resources are programs such

as free mental health and standard

care through local departments of

social services, Crime Stoppers

hotlines, the Big Brothers Big

Sisters program, community centers,

youth athletic programs, resource
 

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officers, and the 988 Suicide and

Crisis Lifeline and other suicide

hotlines. Some organizations

are researching the accessibility

of resources in communities, as

well as communities’ knowledge

of resources, in hopes of better

execution and results.

There is no such thing as a oneprogram-fits-all cure to community

violence, as communities encompass

so many different cultural, religious,

social, and local practices and

values. This can cause difficulty

in conducting research, trying

to help communities reduce and

cope with violence, and achieving

community cooperation. If

possible, it may be helpful to work

closely with communities and,

specifically, residents who have

experienced violence, in planning

and implementing programs to help

prevent violence. Furthermore, the

amount of trauma and adversity that

many residents from high-violence

communities have suffered can

create substantial barriers.

Trauma-informed care is an

approach that aids in considering

the trauma of an individual through

a social and environmental lens.

Trauma-informed care can be used

as prevention or intervention in

large settings, such as social services

agencies, schools, workplace

environments, healthcare facilities,

and governing bodies. Community

service providers should require

staff to attend a minimum of one

trauma-informed care training a year

when serving at-risk populations

to aid in providing safe prevention

or intervention efforts. Service

professionals must understand the

impacts of community violence

and how it contributes to future

involvement in some individuals in

violence, as a perpetrator, victim, or

witness.

Conclusion

Community violence impacts people

of all races, genders, and ages. These

same people are still functioning on

a daily basis, going to school and

work, while living in fear for their

safety. Violence in communities

not only robs residents of peace

of mind but in some unfortunate

circumstances may also steal their

hope. The work that is being done

to combat community violence is

commendable and will give so many

people their lives back. ■

“

Community violence can cause significant 

physical injuries and mental health conditions such 

as depression, anxiety, and post-traumatic stress 

disorder (PTSD)

”

(CDC, n.d.).

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 15
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Bringing More Voices to the Table(top): 

Planning for Effective Response to Incidents

of Violence 

By Tara Hughes, LCSW-R, and Amanda Eagan, M.A.Ed., Improving Community Preparedness to Assist Victims

of Mass Violence and Domestic Terrorism: Training and Technical Assistance (ICP TTA) Program

The management of an emergency

involves many professional

communities, including first

responders, public health and

behavioral health professionals,

spiritual leaders, and volunteers—

as well as (of course) emergency

managers themselves. Because

of this diversity, different groups

may engage in what Tara Hughes

and Amanda Eagan of the ICP

TTA Program have called “parallel

planning,” which can lead to

response efforts hampered by

inefficiencies, lack of coordination,

and conflict.

Transportation Safety Board liaison management, law enforcement and Hughes and Eagan were recruited for the American Red Cross to plane other first responders, behavioral to lead the ICP TTA Program crashes and as a leader and expert in health care, spiritual care, and victim because of their rich backgrounds responses to mass violence. Eagan, services.

in emergency management for her part, has a background in and incident response—and The Dialogue recently met with emergency management as well in connecting professional Hughes and Eagan to discuss as training and communications. communities. A trauma therapist funding and services in response to Employed by a university when and licensed clinical social worker mass violence, as well as lessons COVID-19 hit, she led the school’s

since 1992, Hughes has served as learned from decades responding to pandemic response for its housing part of responses to 9/11; plane mass casualty incidents. and residence life division, which

and bus crashes; the 2010 Haitian serves about 10,000 students.

earthquake; the Boston Marathon How would you define victim Hughes and Eagan have worked services? bombing (2013); mudslides in Oso, with other experts to identify 16 best Washington (2014); and shootings TH: The term “victim services” is practices in planning that help bring at Sandy Hook Elementary (2012), very broad, and what it includes together those who will be involved in Orlando (2016), and Las Vegas depends on who you talk to. But in response to mass violence (2017). She has served as a National in terms of legislation, funding, incidents, including emergency

Tara Hughes (left) and Amanda Eagan (right) bring rich backgrounds and expertise in emergency

management and incident response.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 16
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

and services, a lot begins with the

Victims of Crime Act of 1984, or

VOCA. Out of VOCA came what’s

called the Crime Victims Fund,

which is a fund that restitution

payments and other non-direct

payments from federal crime go

into, and which channels funding

to the states. The Crime Victims

Fund is administered by the U.S.

Department of Justice’s Office for

Victims of Crime, or OVC.

The Crime Victims Fund goes into a

number of different pots, the biggest

of which are for funding to states

for two purposes. One is victim

compensation, which is a direct

fund that victims of crime get access

to that pays for health services,

surgeries, rehab, mental health, or

other services directly related to the

crime. Each state has a statute that

dictates what it does with the Crime

Victims Fund.

“

As we address the trauma of mass violence, it is also 

important to highlight the fact that the vast majority of 

people with mental health problems are no more likely 

to be violent than anyone else; studies indicate that only 

3–5 percent of violent acts can be attributed to individuals 

living with a serious mental illness. In fact, people with 

severe mental illness are 10 times more likely to be 

victims of violent crime than the general population.

— Miriam E. Delphin-Rittmon, Ph.D., Assistant Secretary for Mental ”

Health and Substance Use, SAMHSA, in a post to the SAMHSA Blog on 

June 16, 2022

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 17

The second pot is crime victim

assistance, and assistance involves a

connection with a victim advocate.

Crime victim assistance also

includes some emergency crisis

funding that can pay for things

that are very directly connected to

a crisis that you might be having.

That could include, in a domestic

violence situation, getting your

locks changed or groceries because

you can’t go to the grocery store.

Assistance is the more flexible part

of the crime victim funding.

Another pot of money that comes

out of the Crime Victims Fund is a

mass violence response fund, and

that fund is translated for the most

part into the Antiterrorism and

Emergency Assistance Program

grants.

An important distinction to

understand is direct versus indirect

victims of crime. According to

OVC, direct victims are those who

are exposed to the sights, smells,

sounds, and tastes of an incident.

Indirect victims are people who

care for or about direct victims and

will help to care for them after the

incident.

OVC considers first responders

to a mass violence event to be

indirect victims. What we know,

starting with 9/11, is that mass

violence decimates first responder

departments. Between 40 and 60

percent of first responders who

support the response to an incident

of mass violence will either change

departments or leave the profession
 

 

 

 

 

 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

altogether. Part of OVC’s response

is trying to help responders so

that doesn’t happen, because it

hurts departments when they lose

that many employees and their

institutional memory.

AE: A big part of victim services

is having an individual that can

help walk you through services you

qualify for that might be helpful for

you—an advocate to walk with you

as you access behavioral health,

victim compensation, or a variety

of other things. It’s a pretty large

bucket. Victim services encompasses

services to meet those needs you

have following a crime.

Have you noticed changes in

preparedness and response

over time?

TH: What I’ve seen over time is

an understanding that we need

mental health and spiritual care

as part of response, as well as an

understanding of the importance of

victim advocacy in response to mass

violence. 9/11 was a pivotal moment

where life changed quite a bit in so

many ways, and specifically in terms

of response. People lived through

terrible things and would need to

manage that going forward, and to

help them do that, response had to

include a mental health/spiritual care

component.

It was during the response to the

shooting in Las Vegas that largescale victim advocacy became

known as best practice and

something people felt was necessary

to include in response. I think part of

that was the fact that you had 22,000

potential victims, and with that

many victims identified by police,

help was needed in managing that

aspect of response.

In terms of planning, what we’ve

seen in most places is parallel

planning, where you have

emergency management and

law enforcement planning for a

disaster. At the same time, you have

victim advocates, some of them

getting trained in crisis response

and understanding the potential is

there to respond to a mass violence

incident. But the integration of those

parallel planning streams has been

really challenging, and not done in

most places. And so that’s what the

ICP TTA Program does: For the first

time, it really says, “We will help

you plan, but you need to have all

sides of the house in the room so that

the planning is integrated and people

know each other beforehand.”

After responding to multiple

incidents, are there things you

know now that you wish you’d

known when you started?

TH: There are a few things I wish

I knew at the beginning. One is

the importance of integrating into

the larger system, the Incident

Command System. Behavioral

“

Current or former workplaces of

perpetrators were the most common sites

for mass shootings. Most of the shooters had been 

fired. . . . Almost all of mass shooters at restaurants,

bars, and retail establishments were strangers to those

businesses, while perpetrators in workplaces, houses of 

worship, and schools and colleges tended to be current or former students and insiders known 

to the victims

”

 (Shahid & Duzor, 2021).

The Century 16 movie theater in Aurora. The

theater was the site of a mass shooting in 2012.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 18
 

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Produced by the SAMHSA Disaster Technical Assistance Center

health is integral to response, but

it’s one piece of many, so just

understanding where you fit in that

bigger system is really important.

The other thing that I wish I knew

starting out was just how flexible I

needed to be. We always talk about

that with behavioral health. In mass

violence response, it is absolutely

huge. You need to be able to say

you’ll do whatever is needed.

Any kind of mass casualty incident,

but in particular, an incident of mass

violence, brings people out because

they want to help. They want to do

something. You get the best of the

best intentions walking in the door,

and people come with their own idea

of what they can do and what they

have to offer. And a lot of times, if

you say to them, that’s really great

and here’s what we need you to do,

people really fight against that, and

that fight is actually not helpful at all.

AE: I think it’s important for people

to think about what they would want

if they were victims of the incident.

It’s helping flip that switch of “this is

what I want to offer” versus “this is

what I would need if I were in their

shoes.”

TH: When I train behavioral health

people to respond to a mass casualty

incident, I always tell them that if I

were seeing someone with trauma

in my office for mental health

treatment, I would have to repeat

myself four or five times before

they really grasp what I am telling

them or asking them to do. In the

first couple of weeks after mass

violence, that goes up to 10 times.

We’re really looking at repetitive

care where you are saying the same

things repeatedly until the victim’s

brain can process the information.

It’s all Psychological First Aid, and

repeating your message enough

times to get people to where they

understand their reactions are

common and to be expected.

It’s also important to understand that

people don’t always have their crisis

immediately after the mass violence

incident. Delayed reactions don’t

necessarily mean that people have

PTSD. They may just take some

time to process what happened.

Their reactions will diminish over

time or spike at different times.

How can communities be

better prepared for an incident

of mass violence?

AE: I think that comes back to

what Tara was talking about with

the parallel planning that happens,

and finding ways to make that

coordinated and not parallel. When

an incident happens, emergency

management is kind of in charge.

Their job is to coordinate the

response. They have Emergency

Support Functions they use to

coordinate the response, which are

their go-to, and that makes a lot of

sense because they’re structured

really well, and they hit a lot of

different needs that people are going

to have, regardless of the disaster.

But mass violence requires you to

think outside of that box, or widen

your box. I think for communities

to be better prepared, they need to

think about widening that box so

that they know what they have, and

they can come up with a plan to help

dispatch all of those resources in a

cohesive and timely way that meets

the needs they have at the time.

TH: I just think that all the people

who will be involved in response

need to be talking to each other, as

Amanda just said. One tool we’ve

created to help is our mass violence

annex template. It is designed to

A part of the mass violence annex template.

help communities develop an annex

to their emergency operations plan

specific to incidents of criminal

mass violence and domestic

terrorism. The template has chapters

corresponding to the 16 best practice

areas, and then each chapter includes

considerations, questions to answer,

and a template to use to create a part

of the annex. A community just has

to sit down in a room together and

ask and answer the questions, and

they’ve got themselves well on the

way to being really well-prepared

for a mass violence incident. ■

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 19
2023 | VOLUME 18 | ISSUE 1–2 | PAGE 20

COMMUNITIES COPING

WITH HATE CRIMES

Hate crimes are at their highest level in 12 years, with over 8,000 reported in 2020.1

Motivated by hatred toward others based on their race, color, national origin, religion, gender, sexual

orientation, gender identity, familial status, or disability, hate crimes vary from attacks on property

to attacks on whole communities. Eleven percent are mass casualty attacks.

Below are recommendations to prepare for, respond to, and recover from a hate crime.

PREPARE RESPOND RECOVER

Build trust. Hate crimes and Center community voices. Remember. Establish an

acts that lead to hate crimes go The media should center voices annual remembrance to allow

underreported. To better prepare of community members impacted the community to come together

communities to report and by the violence. Responders to remember and reflect on the

respond to hate crimes, police should develop materials that are event and continue discussions

need to work on establishing trust culturally sensitive. about reducing hate and building

with all members of communities connections in the community.

they serve. Gather resources. Funds for

victims and survivors may be Educate. Engage with

Increase understanding of needed. Communities should use community members who had

hate crimes and signs that lead to established partnerships to obtain strong voices in the wake of the

them to help encourage reporting funds for repairs, funeral costs, event to help spearhead education

and decrease attacks. and restorative activities. on hate crimes. Encourage crosscultural discussion to increase Form partnerships. Having understanding. partnerships in place can help

Show solidarity through a

gathering, memorial, or vigil.

mobilize resources faster to assist

victims and survivors in their

recovery. 1

 Miller-Idriss & Braniff, 2022

FOR MORE INFORMATION OR RESOURCES 

contact SAMHSA DTAC at 1–800–308–3515 or

email dtac@samhsa.hhs.gov.

Engage. Stay active in the

community to help heal bonds

that may have been broken in the

wake of the attack. Volunteering

and fundraising for victims are

good ways to stay engaged after a

hate crime.
 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Telling Every Story: Building Narratives as a 

Community After Hate-based Mass Violence

By Maggie Feinstein, M.A., LPC, 10.27 Healing Partnership

As a resiliency center, we are tasked

with supporting our community

through deep and unjust tragedy

toward greater resilience. The 10.27

Healing Partnership was formed

in response to the antisemitic and

anti-immigrant mass shooting in

Pittsburgh on October 27, 2018,

when a perpetrator murdered 11

people from the Dor Hadash,

New Light, and Tree of Life

congregations gathered in their

weekly prayer. We work with

individuals, organizations, and

the larger community to promote

mental health, increase community

resiliency initiatives, and coordinate

activities related to Oct. 27th, such

as media, commemoration, and

memorialization efforts.

Community resiliency work

following mass violence offers a

challenge that sets it apart from

other mental health services. Most

professionals would anticipate

deep emotions, pain, and sadness.

However, those who are new to the

work of resiliency centers may not

anticipate the depth to which good

people, under the circumstances of

such a devastating collective trauma,

may cause further harm to one

another in the aftermath and amplify

the pain of the initial event. We work

to understand how this happens, and

what our role as a resiliency center

should be in this conflict.

One focal point of this intracommunity conflict after the

shooting is the control of the

incident’s dominant narrative.

Every mass violence attack and

recovery has a dominant narrative

which is formed both internally

and externally and is significantly

reinforced by national and

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 21

A resiliency center is a site established by a community after a hate crime, incident of mass violence, or

terrorist attack (Office for Victims of Crime, 2015a). The resiliency center is set up and run to meet the needs

of victims, family members, first responders, and community members and others affected by a violent

incident; services may include counseling and therapeutic services, psycho-education, group education,

and connection of individuals to resources

in the community (Office for Victims of

Crime, 2015b). As explained by the ICP TTA

Program at their website, “a resiliency center

or program will focus on the longer-term

needs of victims and/or the local community,

depending on the funding secured. Services

are free for identified and funded populations.

The center provides a safe and supportive

healing environment for individuals and

groups seeking improved emotional and

physical health related to the . . . incident)

(ICP TTA, n.d.).
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Produced by the SAMHSA Disaster Technical Assistance Center

 

international attention and media.

External sources often look for

clear-cut answers, opinions, or

stories that will feel relatable and

easily sympathetic to the public.

Stories that emerge after the mass

shooting can often be individually

positive; we can learn more about

the strength and people within the

community. However, these stories

can be damaging when they coalesce

into a single dominant narrative

instead of acknowledging the true

diversity of perspectives.

This dominant narrative includes,

but is not limited to, what the

political or societal ramifications

of the attack should be, why the

attack happened, and who should be

centered in the aftermath. Living in

Mr. Rogers’ neighborhood we have

so often heard his quote about when

there is tragedy we need to “look

for the helpers.” There are so many

incredible helpers, but not all receive

the same attention. Both in our own

experience, and in our dialogue with

colleagues, we have learned that the

essential efforts within communities

after mass violence have not always

been the focal point of media.

Resiliency centers should strive to

make space in the narrative for the

significance and stories of both those

who are in pain and those who are

helping.

The Effects of the

Dominant Narrative

The 10.27 Healing Partnership exists

within the intimate and historically

Jewish neighborhood of Squirrel

Hill in Pittsburgh, and while the

population we serve shares many

similar demographics, the small

but significant differences and

intersections within the community

hold weight. Invariably in tight-knit

communities we place a lot of value

on other peoples’ decisions and

experiences, especially when they

deviate from our own. When there is

a rigid and strict dominant narrative

in place, deviations or rejections of

that narrative can feel even more

personal. It is always problematic

to speak on behalf of the whole

community or assume that your own

perspective on the mass shooting is

the only valid one. This is intensified

in a community seen by the external

world as a monolith.

In the case of a hate-motivated

mass violence attack, secondary and

vicarious trauma can be incredibly

widespread and damaging. A mass

violence attack is a communal

trauma, and violence that is hatemotivated shatters the sense of

safety and increases vicarious

trauma for anyone who identifies

with the group attacked. In our case,

the attack was on Jewish people who

were participating in the weekly

ritual of communal prayer. Jewish

people both within Pittsburgh and

around the world share this practice,

and all Jewish people can experience

increased fear and anxiety about

being in a similar position as those

who were killed simply for being

Jewish. Yet this vicarious trauma

is highly stigmatized—many feel

that if they were not explicitly and

directed impacted, they do not have

a “right” to consider their own lives

and trauma a part of the communal

story around the event. To heal,

they may need to acknowledge the

legitimacy of their own trauma.

After a mass shooting there are

ripple effects that destabilize

communities trying to find

their balance again. A common

ripple effect is inter-community

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 22
 

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disagreement, frequently based

upon or intensified by the dominant

narratives being told. Without

resolution, these disagreements can

become endemic conflicts. When the

community perceives there is one

dominant narrative, it can negatively

affect healing, community-building,

and resiliency-building. “Sides” may

be formed, and it can feel as though

there is a perpetual conflict over

whose narrative is legitimate.

One of the primary causes of this

conflict is the assumption that there

is a scarcity of who can have a

voice. This assumption stems from

the belief that if an individual or a

group does not supersede another’s

voice with their own, they will be

forgotten and invisible. This belief is

not baseless, and it is the resiliency

center’s role to combat factors that

lead to this scarcity. We should not

underestimate the power of narrative

and voice. If people feel that they,

or the loved one that was taken

from them, will become invisible or

misremembered if they do not fight

to gain ground on others’ narratives,

it can motivate significant conflict.

A resiliency center should seek to

promote and celebrate a variety

of narratives that hold meaning

for the affected individuals and

encourage opportunities for uplifting

new stories. People in pain are not

villains; conflict over this dominant

narrative is predictable and natural,

and not a result of maliciousness or

failure. Community organizations

must take on some responsibility for

productive resolution.

Diverse Narratives and

Communal Narrative-building

We believe that to combat a harmful

dominant narrative, resiliency

centers should strive to uplift

diverse narratives that hold space for

multiple narratives, ideals, priorities,

and voices. They can hold both the

narratives of those who were directly

affected by this shooting, and the

broader narratives of the community

who have experienced secondary

and vicarious trauma.

One strategy toward doing this

is to provide direct, actionable

opportunities for victims to share

their own perspectives. Make space

for them to express who they are and

their own narrative, and to show the

true version of the person that they

loved, free from the “flattening”

A volunteer for The Jewish Cemetery and Burial Association of Greater Pittsburgh at the 10.27 Days of

Service, a collaboration between Repair the World and the 10.27 Healing Partnership. Photo courtesy of

the 10.27 Healing Partnership.

and “hero-ifying” nature of the

media and broader public. These

outlets include both communicating

media opportunities to those

directly affected and finding more

creative options. Our partner, Repair

the World Pittsburgh, has been

invaluable in supporting this work.

Every year for Commemoration we

coordinate with them and the family

members of those who were killed

to identify volunteer activities that

speak to the core values of those

who were killed. This allows for

genuine connection and allows for

more complexity to fill the narrative.

Identify early on areas that will be

emotionally intense to navigate,

such as the annual date of the mass

shooting, when conflicts over the

story and narrative of the event

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 23
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could be retraumatizing. Give the

most directly affected victims the

power to identify those places and

delineate those times clearly. When

a venue requires an apolitical or

more concise approach, define

other opportunities where there is

more space for healthy dialogue or

promotion of different narratives.

A resiliency center’s role here is to

facilitate dialogue safely and hold

curiosity, not to create solutions for

the emotions, feelings, and thoughts

brought up during dialogue.

Because it is not always possible in

every space to hold many different

perspectives at the same time,

activities that encourage communal

narrative-building in a healthy way

are incredibly important. In our

American and Jewish culture, it is

common to create a public memorial

that gives a voice to the tragedy

and the people impacted after a

communal trauma. We centered the

advice of Cliff Chanin, Executive

Vice President and Director of the

9/11 Memorial and Museum: “In a

memorial, the product will always

reflect the process.” If you seek to

center the victims in a memorial,

the process must center their voices.

Facilitated by a trained mediator, the

memorialization group is currently

working to unlearn harmful

perspectives that had been built

in the two years since the attack.

They are working to remove the

baggage of judgment and longheld assumptions, helping to break

down these endemic narratives

and laying groundwork to create

healthier communal narratives in

the future. Over time, we seek to

help community members find

common ground when possible,

and respect overall. As Lauren

Mallinger, daughter-in-law of Rose

Mallinger, who was killed in the

synagogue shooting, put it in the

wake of former President Donald

Trump’s visit to Pittsburgh after Oct.

27, “I understand he had to come

because this was a crisis and it was

his job to show up with his family.

So when he did come, we joined

the rally and sang peaceful Jewish

songs.” Healthier dialogue and

healthier narratives lead to greater

empathy, respect, and peace among

community members with differing

perspectives.

Refocusing on Connections

and Community

A clear understanding of secondary

and tertiary trauma is essential for

a resiliency center and community

members. The goal is not to “rank”

Participants in 10.27 Healing Partnership’s drum circle program led by Stephanie and Bob Miller. This

program highlights community building and the release of emotion through rhythm and communal music.

Photo courtesy of the 10.27 Healing Partnership.

 

who is the most victimized. The goal

is for people to hold the empathy

and nuance to understand where

they fall in the concentric rings of

trauma, and therefore to hold the

agency to both speak from their

own perspective and seek their own

healing while not overshadowing

those who are directly impacted in

ways they were not. Education and

empathy-building can reduce the

risk of conflict between secondary

and primary victims over who is

allowed to have a voice. Mediation

is far more successful when

all victims feel acknowledged

and heard and have engaged in

introspection related to their own

positioning within the event.

Secondary and vicarious trauma

is real and deeply painful, and a

resiliency center should strive to

forge more diversity in the story and

the ecosystem of resources after the

event that allows for survivors in all

spheres of victimization.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 24
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Rosh Chodesh is a Jewish ritual to mark the beginning of the Hebrew

months. Rosh Chodesh Elul marks the start of the month of Elul in

the Jewish calendar (Jewish Federation of Greater Indianapolis, n.d.).

Elul precedes Tishrei, the month in which the Jewish High Holidays

are celebrated, considered by many Jews to be the holiest time of the

year, and immediately followed by the date of the shooting. Elul is a

time to prepare for the High Holidays, and then also anticipating and

preparing for the commemoration of the shooting (Hammer, n.d.).

Observances emphasize restoration and renewal (Splansky, 2012).

Anyone who was a witness or

whose loved one was killed is

clearly impacted and identifiable,

but there are many who experienced

trauma who go unidentified. As

time passes we begin to hear from

individuals who feel marginalized

or invisible after the shooting, either

because they were unidentified

or because they held different

perspectives about the shooting or

its ramifications. Acknowledging

the response and reactions of people

who are not as directly impacted can

benefit the community as a whole.

As we include diverse voices we

can allow the narrative to deepen

and allow those who were directly

impacted to hold evolving and

varying viewpoints.

When a communal trauma impacts

the group norms of a community

there is an opportunity to rebuild

some new norms based on old

values. It is possible to use the

foundation of any shared cultural

values, celebrations, and meeting

places for our own collective joy.

For example, in 2019 we organized

a Rosh Chodesh Elul event for

the community. As we were

still reeling from the synagogue

shooting, the anticipation of the first

commemoration was heavy and

frightening. Our incorporation of

Jewish ritual around Rosh Chodesh

Elul and the Jewish values of

learning and education into an event

about mindfulness and mental health

helped to prepare our community in

a culturally informed way. Reviving

rituals that receive little attention,

such as Rosh Chodesh Elul, in a way

that can celebrate our identity and

resilience, is a technique we carry

forward with us. In our ongoing

work we lean into Jewish ritual and

values, such as grieving rituals and

work toward repairing the world, to

further our community’s healing.

Work to refocus on the shared

foundation of values and emphasize

your understanding that the

community is not a monolith and

that people are not expected to “fall

into line,” and that diversity of

opinions is invited. We all agree that

we never want anyone to experience

such a traumatic loss as our

community did on October 27, 2018,

and it is important to remember

these similarities in times when the

community may be struggling over

who gets to “own” the narrative and

story.

Over time, the dominant narrative

will always change. Those who felt

like their stories were originally

centered may feel cast off, and those

who felt neglected may find the

space to share. Instead of adding

to this chaotic cycle, everyone in

the community has a part to play

in creating diverse narratives.

A beautiful start to healing is to

become curious about whose story

has and has not been heard and

the emotions you are feeling about

the place you hold in the narrative.

Resiliency centers and community

organizations should consider the

ways they may be unwittingly

collaborating toward a single

dominant narrative and the role they

can instead play in uplifting diverse

voices while maintaining a victimcentered approach. It will not be a

linear process, but celebrating and

respecting one another’s stories is

key to long-term collective healing:

staying invested in continuing this

journey together. ■

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 25
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Disaster Preparedness and Recovery in the

Context of Community Violence: Recognizing 

and Repairing Fragile Relationships To 

Minimize Harm

By Patricia Campie, Ph.D., American Institutes for Research

Community-based violence impacts

the physical, social, emotional, and

mental well-being of those directly

victimized, while traumatizing

bystanders and instilling fear

throughout a community. The

financial consequences of

community-based violence are widereaching, totaling close to $3 trillion

annually (Miller et. al, 2021).

The causes of community-based

violence are complex, but in places

that experience persistent violence,

social structures and institutions

through absence or oppression often

limit individuals from accessing

basic protections, placing them at

greater risk for injury, disease, and

premature death (Dong, White, &

Weisburd, 2020). For example, when

schools are not well maintained, still

contain dangerous building materials

(e.g., asbestos, lead), or are located

in areas that do not have sufficient

health and safety protections,

such as crosswalks, street lights,

or bus stops, children attending

these schools are at greater risk for

health-related problems, as well

as exposure to victimization and

violence in these environments that

are unmonitored and abandoned.

This type of structural violence has

its heaviest impacts on individuals

in lower socioeconomic classes,

leading to the highest rates of

disease and death, unemployment,

homelessness, lack of education, and

civic powerlessness in a community.

Structural violence is closely linked

to social injustice and different types

of interpersonal and state-involved

forms of violence (Van Soest &

Bryant, 1995). Communities and

people who are marginalized

geographically, economically,

linguistically, or culturally are more

vulnerable to persistent violence that

can become generational over time.

Those hardest hit by the tragedy of

Hurricane Katrina, and hurricanes

since, were also communities

plagued by high levels of

Contractor installs the Blue Roof on Biloxi, Mississippi homes damaged by Hurricane Katrina. Photo by

The U.S. National Archives

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 26
 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

“

Mass shootings 

are statistically rare, 

accounting for fewer 

than 1 percent of all 

firearm homicides in 

the United States

(Shahid & Duzor, 

”

2021).

>1%

community violence driven by

decades of structural disinvestment.

In these low-income communities,

housing structures were often

substandard and located in areas

close to other hazards (e.g., chemical

factories impacted by the storm) and

isolated from rescue services.

Families in need of home repairs

after the storm had a hard time

accessing funds due to low credit

scores, loss of employment,

insufficient savings, and other

personal barriers (e.g., disability,

language barriers). Relocation for

these families was not an option, as

those costs are high, and they would

be leaving their entire informal

support system of family and friends

(Krause & Reeves, 2017).

These structural deficits led many

of these same communities to

have historically persistent levels

of community-based violence

(Sharkey & Marsteller, 2022).

Abandoned housing becomes a

haven for drug dealing that can often

lead to violence as conflicts erupt

between rival dealers. Residents

are either afraid to call the police

due to fear of retaliation from those

committing the violence or they

have experienced a lack of police

response when they do call 911,

a problem that plagues Black and

Brown communities (Weisburd,

2021). Financial constraints make

it nearly impossible to relocate to

a safer community, as does lack

of affordable housing. As a result,

the violence continues, community

trauma deepens, institutional distrust

builds, and vulnerability to crisis

increases.

Resilience in the face of violence

and victimization requires a mix

of supports that promote healthy

youth development and family

functioning, while strengthening

institutions to offer meaningful

education, employment, and health

resources to reduce risk for violence

and recover from its effects after it

occurs.

If there is not a trusting relationship

between government institutions and

the community, the community is

not likely to respond to governmentinitiated prevention strategies or

have the resilience to bounce back

after tragedy occurs (Bolger &

Walters, 2019). To ensure that these

fragile communities are able to

benefit from disaster preparedness

and recovery resources, systemlevel reforms must address

community trust. There must be

investment in building the capacity

of neighborhood-level resources

that can bridge the gap between

wary residents and government

agencies that have let them down for

generations.

The effectiveness and legitimacy

of human-serving systems in the

United States has never been more

in question following a global

pandemic and the historic and

persistent police killings of Black

men and women, as well as rising

rates of community-based violence.

For almost 2 years, schools were

unable to teach, hospitals were

under-equipped to treat, businesses

were shuttered, homelessness

increased, and there were urgent

calls to defund the police and

remove political leaders at all

levels of government. Although this

has been a time of unprecedented

institutional breakdowns occurring

at the same time, it provides an

equally unprecedented opportunity

for change.

Reducing the structural drivers of

community violence can save lives

from human conflict, and also help

the most vulnerable communities

prepare for and recover from the

natural disasters that all communities

inevitably will face. ■

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 27
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Supporting Resiliency in Communities Affected 

by Violence: Responding to Incidents in the 

United States and Around the World

By Robert D. Macy, Ph.D., DMT, International Trauma Center

The violence inherent in many

human-caused disasters, such as

mass shootings and acts of terrorism,

requires that the purpose and

focus of psychosocial intervention

and behavioral health disaster

management is no longer only about

meeting physical and material needs.

Psychosocial intervention must also

respond to a wider range of factors

causing physical and nonphysical

human suffering. Stabilizing the

physical condition of human beings

does not necessarily ameliorate their

overall degraded circumstances nor

does it eliminate the potential for

greater pain and increased suffering.

Separation from family, the

destruction of community solidarity,

the interruption or cessation of basic

education, an inability to create an

adequate livelihood, continual fear

of abuse and concomitant retaliatory

violence, deep betrayal and

resentment, and personal remorse

and guilt are defining characteristics

of violence exposures.

Understanding and Assessing

Communities Affected by

Violence

When managing behavioral

health responses in international

and U.S. communities exposed

to violence, it is important to

Participants in a project with children in western Nepal orphaned by execution during the Maoist revolt or

civil war. Photo by Robert D. Macy.

conduct an assessment to gain

extensive awareness of current local

conditions. When conducting an

assessment, managers should work

to understand the following:

• Cultural, social, and economic

patterns.

• National or international and

humanitarian law.

• The context of the violence in

light of its political, human rights,

social, development, and military

implications.

• The trauma or violence exposure

variables and dynamics of conflicts

and overwhelming events.

• Local capabilities, including

the innate capacities of the

community. In short, which

survivors are already emerging as

leaders?

• Local idioms of distress and

eustress—the Traumascape.

• Local resource capacities to

specifically address both the

fundamental acute and longerterm psychosocial disruptions

occurring during and after violence

exposure (ecology of recovery and

community tolerance).

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 28
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Disaster behavioral health

management of violence must then

address the underlying intense

psychological dysregulation at the

individual and group levels that

often occurs as a result of exposure

to violence.

Because memories of violence and

bloodshed tend to remain fresh in

the minds of impacted populations,

they can not only hurt individuals

but undermine intergroup harmony

and cooperation. Highly traumatized

individuals unfortunately often

engage in coping strategies, such

as substance use and violence

directed at themselves and others,

that also undermine their ability

to become securely engaged

in education, employment, or

successful parenting. The struggles

of these individuals and their coping

behaviors serve as a community

reminder of past offenses. Culturally

sensitive, highly structured,

evidence-based programs addressing

the fundamental components of

psychosocial disruptions and the

underlying psychological trauma

that can sustain destructive coping

strategies can, therefore, benefit

the individuals as well as the

community as a whole. In fact, the

support and development of such

psychosocial intervention structures

may significantly reduce the midto long-term costs of recovery and

reunification post-conflict. These

psychosocial intervention structures

have a fundamental focus: how to

engage survivors in transformational

experiences that access the human

resiliency response.

Programmatically, helping to

stabilize and eventually heal those

psychologically impacted by

The Classroom-based Intervention program (CBI) is a systematic

expressive-behavioral program, involving a series of activities

which aim to reduce the post-traumatic stress reactions, through the

help of what children do the best: playing and learning (Munir et

al., 2004). It is a recovery-focused and resiliency-based program.

The design is based upon the proven assumption that an immediate,

trauma-specific, short-term response for children who have been

exposed to life-threatening disasters may significantly decrease the

overall negative effects of the disaster experience. The ultimate goal

is to bring about immediate short-term benefits as well as long-term

preventive effects. The expected (immediate) positive results may

include a significant reduction in somatic symptoms such as sleep

and appetite problems, an increase in constructive peer relations,

an improvement in attention and learning, and an increase in selfesteem and in the sense of safety and control.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 29

exposure to extreme violence is

critical. As new datasets are being

analyzed, we may see perhaps that

the most cost-effective interventions,

after violence, will be required to

include a structured, evidence-based,

community-managed psychosocial

component targeting activation

of resiliency responses. Current

research is indicating that the

costliest and longest-term negative

impacts of trauma exposure,

violence, and identity conflicts,

and unfortunately the most difficult

to address, are the longitudinal

psychosocial disruption and

attendant psychological impairment,

both of which can significantly

undermine the rebuilding and

stabilization of social capital and the

reintegration of the community.

Community Violence and

Children

Proliferation of targeted aggression

has become the norm in many

communities across the United

States (U.S. Attorney General’s

National Task Force on Children

Exposed to Violence, 2012). The

intensive longitudinal impact of

trauma and resulting violence

on students, classroom wellness,

and student’s learning styles

is still under-researched and

misunderstood, but teachers, support

staff, and administrators working

in the 97,500 public schools across

America see the impact every

day. School staffs deal with the

consequences of trauma, animosity,

targeted aggression, racism, and

impoverishment every day. The
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

socioemotional and resiliency

curriculum must be developed to

support and enhance the academic

curriculum to minimize the negative

effects of trauma and violence and

maximize individual learning styles.

Macy and colleagues, working with

national and international donors

over the last 25 years, have launched

school-focused, evidence-based,

highly structured psychosocial

intervention programs, such as

the CBI® services continuum, for

children and youth exposed to armed

conflict and mass casualty natural

disasters (Sahin, Batigün, & Yilmaz,

2007). It is important to note that

our efforts and our resources are

aimed at what appear to be the

most at-risk populations impacted

by community violence: children

and youth. In an epidemiological

study by Macy (Unpublished, 2000)

Medicaid youth living at the poverty

level in U.S. Department of Housing

and Urban Development housing

exhibited some of the highest rates

of severe mental health disturbances

yet reported: 609.5 per 1,000 (CI:

601.0–618.0) for the 5- to 12-yearold age group. These youth were not

exposed to a discrete threat event

but rather have suffered continuous

chronic exposure to community

violence, an environment not

dissimilar to communities impacted

by armed identity conflict or

community violence and repeated

mass casualty events.

We are concerned that when high

rates of psychosocial disturbances

and resultant mental health disorders

There is no single, 

official, agreedupon definition of 

an incident of mass 

violence or a mass 

shooting (Soni & 

Tekin, 2022).

arise among youth in violenceexposed conflict areas, which

tragically now includes urban

and suburban school districts in

the United States, and these rates

go unchecked, the economic and

societal consequences for that

community may be overwhelming

and too costly to rectify in a timely

manner. Our method has been and

will continue to be the application

of state-of-the-art school-based

psychosocial assessment and

intervention programs targeting the

impacted youth in regions requesting

psychosocial stabilization and

traumatic stress reduction programs.

These CBI® service continuum

programs have been implemented

in the United States and other

countries under extraordinarily

difficult circumstances. Research

results indicate that younger children

(5–12 years old) respond much

better than older children who have

been exposed to combat and war.

PTSD symptoms were significantly

reduced, and hope was instilled and

rebuilt. Depressive symptoms and

functioning did not significantly

change.

More research and intervention

development is needed to address

the current impact of violence

exposure among our developing

youth. The powerful positive impact

of organizing local leadership and

impacted citizens to access resources

and learn how to implement the

CBI® with their own children and

loved ones cannot be underestimated

and is currently being studied. The

ecology of successful long-term

recovery responses after violence

exposure appear to be hinged

most significantly on empowering

impacted communities to embrace

vulnerability dynamics and access

group resiliency response.

We acknowledge that there are no

blanket prescriptions for healing

wounds and rebuilding communities

and that reestablishing community

cohesion is an internal process, not

one that can be imposed from the

outside. Each step must be taken

when the time is right and the

participants ready. Nonetheless,

we have learned that outsiders

can play an important role in

preparing, supporting, and otherwise

encouraging community healing,

primarily by working carefully with

local partners to build knowledge

infrastructure that affords those

most impacted by the violence the

opportunity to play a central role

in the stabilization and recovery of

their own community. ■

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 30
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

RECOMMENDED RESOURCES

Tips for Survivors: Coping With Grief After

Community Violence

This tip sheet from SAMHSA contains information

about some of the signs of grief and anger after an

incident of community violence and how to cope. It

lists reactions that children may experience—including

depression, posttraumatic stress, and risky behavior—

and how to help them.

This resource is available through the SAMHSA Store at

https://bit.ly/3xOv0d8. 

Resources for Survivors and the Public Following

Disaster and Mass Violence

The National Center for PTSD has a web page of

resources available with information and tools to help

you deal with the stress you may feel after a disaster or

mass violence event. Resources cover how to cope in the

short- and long-term, self-care, triggers, and printable

handouts. Many of the resources are also available in

Spanish.

Find the resources at https://bit.ly/3r43hkS. 

Community Violence

The National Child Traumatic Stress Network (NCTSN)

has a page on community violence and the common

types that affect youth, including bullying and shootings

in public areas. Living with chronic community violence

can cause youth to lose their sense of safety. This page

leads to a list of NCTSN resources on how to help

youth, create supportive environments, and more.

Find the resources at https://bit.ly/2OVKtjT. 

Mass Disasters, Trauma, and Loss

The International Society for Traumatic Stress Studies

developed this six-page pamphlet to help you better

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 31

understand what to expect after experiencing a disaster,

whether natural or human-caused. It covers reactions in

a variety of categories, including emotional, cognitive,

physical, interpersonal, and spiritual. It provides steps

to help reduce stress and when it may be time to seek

professional help. This resource is also available in

Arabic, Chinese, and Spanish.

Find the pamphlet at https://bit.ly/3DORvm4. 

Violence Prevention

This page from the Centers for Disease Control and

Prevention explains what community violence is and

how some populations are disproportionately impacted

by it. Community violence can not only lead to physical

injuries but can leave individuals with mental health

conditions such as anxiety and PTSD.

This page is available at https://bit.ly/3S5fB02.

Tips for Young Adults: Coping With Mass Violence

This tip sheet describes how incidents of mass violence

can affect young adults ages 18 to 26. It identifies

common reactions young people may have to mass

violence and offers suggestions for coping and

enhancing resilience.

Access the tip sheet at http://bit.ly/3m0vFVR. 
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Recent Technical Assistance Requests

In this section, read about responses SAMHSA DTAC staff have provided to recent technical assistance (TA) requests.

Send your questions and comments to dtac@samhsa.hhs.gov.

Request: A representative from the Disaster

Behavioral Health Services Texas Health and Human

Services Commission requested trainings and resources

on mass violence for disaster behavioral health

professionals.

Response: SAMHSA DTAC provided a list of

trainings and resources on mass violence. The resources

below are a sample of those sent. For additional

information, please contact SAMHSA DTAC at 1–800–

308–3515.

 Crisis Services: Meeting Needs, Saving Lives—The

book is composed of SAMHSA’s “National Guidelines

for Behavioral Health Crisis Care: Best Practice

Toolkit” and related papers on crisis services. The

toolkit reflects relevant clinical and health services

research and offers a review of top national program

practices, as well as replicable approaches that support

best practice implementation. https://store.samhsa.gov/

product/crisis-services-meeting-needs-saving-lives/

PEP20-08-01-001

 Resilience and Coping Intervention (RCI)—

This intervention can be used to help children and

adolescents cope with disasters and other forms of

community trauma. RCI is designed for groups of 5

to 10 people and can be delivered in one or several

sessions. RCI groups can be implemented in programs

based in schools and other settings and led by teachers,

counselors, or other professionals who have been

trained in the intervention. https://dcc.missouri.edu/rci.

html

 Helping Victims of Mass Violence & Terrorism

Toolkit—Available through the website of the

Office for Victims of Crime Training and Technical

Assistance Center, this toolkit includes information

and resources to help communities prepare for and

respond to incidents of mass violence and terrorism.

While some parts of the toolkit focus on steps to take

before an incident, other sections are designed to

support responders in participating in and managing

effective response and recovery processes. https://

www.ovcttac.gov/massviolence/?nm=sfa&ns=mvt&n

t=hvmv

 Unexpected Challenges for Communities in the

Aftermath of a Mass Violence Incident—This tip

sheet from the National Mass Violence Victimization

Resource Center lists some unexpected issues a

community may encounter after experiencing a

mass violence incident. The document also provides

suggested solutions for managing these challenges and

prioritizing a community’s safety and recovery. https://

nmvvrc.org/media/301cm3if/tipsheet2.pdf

 Recovery From Large-Scale Crises: Guidelines for

Crisis Teams and Administrators—In this tip sheet,

the National Association of School Psychologists

(NASP) describes what to expect in schools after

disasters and other crises and how school crisis teams

and administrators can support the school community

in coping and recovery. NASP identifies steps

administrators and crisis teams can take at different

points after the crisis, from immediately after the crisis

to more than a year later. https://www.nasponline.org/

resources-and-publications/resources-and-podcasts/

school-climate-safety-and-crisis/school-violenceresources/recovery-from-large-scale-crises-guidelinesfor-crisis-teams-and-administrators

Request: A representative from the U.S. Public

Health Service requested resources in response to the

Ukrainian refugee crisis.

Response: The resources below are a sample of those

sent. For the complete resource list, please contact

SAMHSA DTAC at 1–800–308–3515.

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 32
 

 

 

 

 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

 Tips for Survivors of a Disaster or Other Traumatic

Event: Managing Stress—This SAMHSA tip sheet

gives stress prevention and management tips for

dealing with the effects of a disaster or trauma. It

identifies common reactions to disasters and other

traumatic events, lists tips to manage and lower stress,

and highlights signs of the need for professional

support. https://store.samhsa.gov/product/Tips-forSurvivors-of-a-Disaster-or-Other-Traumatic-EventManaging-Stress/SMA13-4776

 Mental Health Considerations After a Traumatic

Event—A product of Voices Center for Resilience,

a nonprofit formed after the attacks of September

11, 2001, this tip sheet highlights common reactions

to acts of violence, including war, as well as civil

unrest and terrorism. It identifies signs of the need for

professional mental health support, coping tips during

short- and long-term recovery, and signs of mental

illnesses that may arise in the aftermath of exposure

to violence. https://media.voicesofseptember11.org/

projects/tipsheets/trauma_tips_mentalhealth_001.pdf

 Coping With Distress After International Disasters:

Tips & Resources for Individuals, Families &

Communities—This guide from Vibrant Emotional

Health is a collection of resources and information

for those experiencing anxiety, fear, confusion, or

loneliness during and after an international incident.

It includes links to Person Locator resources, tips for

self-care, and links for more help. https://www.vibrant.

org/coping-with-distress-after-international-disasterstips-resources-for-individuals-families-communities/

 Understanding Child Trauma—This web page from

SAMHSA presents statistics on child trauma, which

may be experienced as part of a natural or humancaused disaster, and lists signs of traumatic stress in

children and youth. It also offers tips for parents and

other caregivers for helping children and youth cope

with trauma. Links are also provided to downloadable

infographics in English and Spanish provided by the

SAMHSA National Child Traumatic Stress Initiative.

https://www.samhsa.gov/child-trauma/understandingchild-trauma

Request: SAMHSA requested a resource letter in

response to threats against historically Black colleges

and universities.

Response: The resources below are a sample of those

sent. For the complete resource list, please contact

SAMHSA DTAC at 1–800–308–3515.

 Tips for College Students: After a Disaster or Other

Trauma—This fact sheet from SAMHSA describes

common reactions to trauma and provides coping

strategies and stress management tips for college

students. This fact sheet is also available in Spanish at 

https://store.samhsa.gov/product/Tips-for-CollegeStudents-After-a-Disaster-or-Other-Trauma-SpanishVersion-/SMA13-4777SPANISH. https://store.samhsa.

gov/product/Tips-for-College-Students-After-aDisaster-or-Other-Trauma/SMA13-4777

 Tips for Survivors: Coping With Grief After

Community Violence—This SAMHSA tip sheet

identifies signs of grief and anger after an incident of 

community violence, provides useful information

about to how to cope with grief, and offers tips for

helping children with coping. https://store.samhsa.

gov/product/Coping-With-Grief-After-CommunityViolence/SMA14-4888

 Mass Violence and Behavioral Health—This edition 

of the SAMHSA Disaster Technical Assistance Center 

Supplemental Research Bulletin provides information 

about the effects of mass violence and explores 

interventions to support coping and stress

management. https://www.samhsa.gov/sites/default/

files/dtac/srb-mass-violence-behavioral-health.pdf

 College Students: Coping After the Recent Shooting

—Written for students at a college or university where 

there has been a campus shooting, this NCTSN tip 

sheet identifies common reactions to an incident of 

mass violence and effective ways

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 33
 

 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

of coping. The tip sheet concludes by encouraging

readers to tap into their networks of support. https://

www.nctsn.org/resources/college-students-copingafter-the-recent-shooting

 Helping Youth After Community Trauma: Tips

for Educators—In this one-page tip sheet, NCTSN

identifies 10 ways youth may react to community

traumas and suggests ways for educators to

respond to these reactions and support youth in

coping. The tip sheet also advises educators to find

professional mental health support for youth—and

for themselves—as needed. https://www.nctsn.org/

resources/helping-youth-after-community-trauma-tipseducators

Request: SAMHSA requested resource letters in

response to the shooting at the Brooklyn Subway Station

in New York.

Response: The resources below are a sample of those

sent. For the complete resource list, please contact

SAMHSA DTAC at 1–800–308–3515.

 Mass Disasters, Trauma, and Loss—This booklet

from the International Society for Traumatic Stress

Studies discusses common reactions to disasters,

factors that make people more likely to experience

reactions for longer periods, and steps survivors can

take to cope effectively after a disaster. Signs of the

need for professional mental health assistance are

also provided. https://istss.org/ISTSS_Main/media/

Documents/ISTSS_MassDisaterTraumaandLoss_

English_FNL.pdf

 Mass Violence/Community Violence—This

part of the SAMHSA Disaster Behavioral Health

Information Series resource collection focuses on

incidents of mass violence, community violence,

and terrorism and their effects. Resources discuss

common reactions to incidents of mass violence, tips

for coping, and ways to support children and youth

in coping. https://www.samhsa.gov/resource-search/

dbhis?rc%5B0%5D=type_of_disaster%3A20549

 Improving Community Preparedness to Assist

Victims of Mass Violence and Domestic Terrorism:

Training and Technical Assistance (ICPTTA)

Program—Funded by the Office forVictims of Crime

within the U.S. Department of Justice, the ICP TTA

Program works to equip U.S. communities to respond

effectively to incidents of criminal mass violence and

domestic terrorism. The program’s website features a

resources page (https://icptta.com/resources), which

offers vetted resources to help emergency managers,

victim service professionals, and others make victim

services part of emergency operations plans, as well as

a trainings page (https://icptta.com/trainings), which

includes freely available trainings to help build local

capacity. https://icptta.com

 Remembering—National Mass Violence

Victimization Resource Center (NMVVRC) This web

page describes how communities typically respond in

grief after an incident of mass violence and offers

guidance for community leaders in supporting

communities through this process. Information

and downloadable resources focus on communities

remembering tragic events, incident anniversaries, and

memorials. https://www.nmvvrc.org/communityleaders/rebuild-your-community/remembering

 Talking to Children About the Shooting—In this tip

sheet, the NCTSN provides suggestions to parents and

other caregivers for talking with their children in ways

that help them to make sense of and cope with their

reactions to a shooting. The tip sheet also identifies

reactions common in children and teens to shooting

incidents. https://www.nctsn.org/resources/talkingchildren-about-shooting

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 34
 

 

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Produced by the SAMHSA Disaster Technical Assistance Center

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bca.2020.36

Help Improve SAMHSA’s Disaster 

Services and Products

As a subscriber to this

newsletter, you are

invited to participate in

a short, web-based

survey to provide the

SAMHSA Disaster

Technical Assistance Center (DTAC) with feedback

about your experiences with our products and 

services. The survey should take no more than 15 

minutes. Complete the survey by going to the 

survey web page, or copy and paste the URL

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2023 | VOLUME 18 | ISSUE 1–2 | PAGE 35
 

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Miller-Idriss, C., & Braniff, B.

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The views, opinions, and content 

expressed in this publication do not 

necessarily reflect the views, opinions, 

or policies of the Center for Mental 

Health Services (CMHS), the Substance 

Abuse and Mental Health Services 

Administration (SAMHSA), or the U.S. 

Department of Health and Human 

Services (HHS).

2023 | VOLUME 18 | ISSUE 1–2 | PAGE 36
Prepare • Respond • Recover

Inform • Assist

CONTACT US

SAMHSA Disaster Technical 

Assistance Center

Toll-free: 1–800–308–3515 

dtac@samhsa.hhs.gov

https://www.samhsa.gov/dtac

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The SAMHSA Disaster Behavioral Health Information Series contains resource collections 

and toolkits pertinent to disaster behavioral health. Installments focus on specific populations, 

specific types of disasters, and other topics related to all-hazards disaster behavioral health 

preparedness and response. Visit the SAMHSA DTAC website at 

https://www.samhsa.gov/resource-search/dbhis to access these materials.