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Article 12

Critical Issues in Implementing the New CACREP Standards for Disaster, Trauma, and Crisis Counseling

Jane M. Webber & J. Barry Mascari

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Paper based on a program presented at the 2009 American Counseling Association Annual Conference and Exposition, March 19-23, Charlotte, North Carolina.

After September 11, 2001, increasing attention has focused on the counselor’s role in disaster and trauma response (Smith, 2005; Uhernik, 2008; Webber, Mascari, Dubi, & Gentry, 2006). The American Counseling Association (ACA) partnered with the American Red Cross to provide disaster mental health specialists after 9/11 and subsequent hurricane relief efforts, and thousands of counselors volunteered for deployment. During this time counselors and organizations of trauma professionals raised concerns over the depth and quality of counselors’ disaster response preparation.

During the standards review process in 2006, the Council for Accreditation for Counseling and Related Standards (CACREP) received a federal grant to study the need for counselor training in emergency preparedness and response (Beckett, 2008). During the draft review period, feedback solicited from counseling professionals indicated strong support for CACREP’s initiative. The 2009 CACREP Standards (CACREP, 2008) provide competencies for crisis, disaster, and trauma response that are infused in both core counseling and program specific curricula (Table 1). These standards represent a major shift from basic counselor training requirements to an infusion of disaster and trauma competencies across counselor preparation. Carolyn Beckett (2008), Project Manager for the Department of Health and Human Services grant, cited the importance of the new standards:

The emergency preparedness language incorporated into the third draft of the standards, in alignment with the National Response Framework, reflected the knowledge and skills counselors have utilized during recent community, regional and national emergencies, including university shootings, bridge collapses, uncontrolled wildfires, hurricane devastation and terrorist attacks. (p. 1, 8)

This article discusses the relevance of the new counselor standards to professional training and practice, describes organizations providing certification, accreditation, and resources, and identifies issues requiring consideration when implementing the new CACREP standards.

The Call for Standards: Progress

Howard Smith (2005), an American Red Cross Disaster Mental Health Trainer, was one of the early counselors to caution, “Providing mental health services in a disaster environment requires an additional set of skills that are noticeably lacking in counselor education programs” (p. 37). Webber and Mascari (2005) advised that a critical lesson learned from September 11th and its aftermath was the need for readily available appropriately trained disaster mental health volunteers. Webber, Mascari, Dubi, and Gentry (2006) addressed nine issues related to trauma counseling and laid the foundation for trauma initiatives with counselors in the ACA Trauma Interest Network who shared similar concerns. Two critical issues called for the inclusion of crisis and trauma training in counselor education programs and the development of training models and curriculum.

Green Cross Academy, the Association of Traumatic Stress Specialists (ASTSS), and other private organizations offer accreditation or certification for mental health professionals. However, none has been universally adopted as the standard in the field, making the establishment of counselor preparation standards even more critical. The American Red Cross requires licensure as a mental health professional for Disaster Mental Health Services training and work. The Uniform Emergency Volunteer Health Care Practitioners Act (National Conference of Commissioners on Uniform State Law, 2006) also requires licensure; however, based on their national certification, National Certified Counselors and Certified Rehabilitation Counselors are authorized to provide services.

With CACREP’s new standards and the State of New Jersey’s Disaster Response Crisis Counselor (DRCC) certification, the counseling profession has made substantial progress toward the establishment of a common credential. Charles Figley, founder of Green Cross Academy and the International Society for Traumatic Stress Studies (ISTSS), provided further evidence of the counseling profession’s pioneering effort to establish training standards. In a keynote address at the January 2008 conference of the American Association of State Counseling Boards (AASCB) in New Orleans, Figley (2008) praised the standards and pronounced them as the cutting edge. After reviewing Draft 3 of the 2009 CACREP Standards, Figley announced that, based on the new standards, professionals graduating from a CACREP accredited program would be automatically certified by Green Cross.

After September 11th, the State of New Jersey Mental Health Services Disaster and Terrorism Branch partnered with the Mental Health Association in New Jersey and the Certification Board, Inc. to establish the DRCC credential in 2007 (New Jersey Department of Human Services [NJDHS], 2008). Training requirements for the DRCC are organized on a four-tiered curriculum with specific skills and competencies. All levels require Incident Management Command System (ICS-100), National Incident Management (NIMS-700), and courses in disaster mental health, psychological first aid, ethics in crisis response, and cultural diversity. Advanced coursework is required in grief, trauma, crisis response, and family and group work for Level I licensed mental health professionals, and for team leaders (NJ Disaster Mental Health, 2007).

As of August 2008, more than 540 DRCCs have been approved, and 980 applicants are working toward certification (NJDHS, 2008). Future plans anticipate issuing standardized identification badges to allow DRCCs to travel during states of emergency, and providing advanced continuing education to keep counselors current with outcome based practices.

Implications of the CACREP Standards for Counselor Educators

Counselor educators and professionals unfamiliar with this growing specialty will need to be well versed in the theory and practice of traumatology, crisis intervention, and emergency preparedness in order to infuse new standards into program objectives and syllabi. Six general guidelines are presented to assist counselor educators and professionals in insuring compliance with the new standards.

Know the Organizations and Government Agencies and Their Purposes

Numerous organizations and government agencies provide services, accreditation, certification, and training resources for emergency preparedness; and disaster, crisis, and trauma response. Prominent organizations are described in this section with the website address, major publications, and the mission or purpose quoted from the website.

American Red Cross (ARC).The American Red Cross provides immediate response each year to more than 70,000 disasters, primarily fires. Courses are offered in all aspects of emergency preparedness and response. “Disaster Mental Health Services staff are licensed mental health professionals trained to recognize the emotional impact of a disaster on those affected—both victims and workers” (Disaster Services, n.d.). They are required to complete the course Foundations of Disaster Mental Health “to provide for and respond to the psychological needs of people across the continuum of disaster preparedness, response, and recovery” (Foundations, 2005). Publications: Many available in several languages such as Facing Fear: Helping Young People Deal with Terrorism and Tragic Events; Disaster Preparedness for People with Disabilities. http://www. redcross.org/

Association of Traumatic Stress Specialists (ATSS). With members worldwide, ATSS is “dedicated to excellence in training, education and experience to ensure that victims of crime, abuse, war, terrorism and disasters receive the most compassionate and effective care as possible” (Mission, n.d.). ATSS provides a comprehensive international certification program; a certified sponsor consults with the applicant throughout the process. Certified Trauma Specialist requires 2,000 hours of experience specific to trauma; 240 hours of core courses and trauma-specific training; and 50 hours of the applicant’s own counseling “to recognize and address those areas which may compromise or enhance the counselor’s ability to provide assistance to trauma victims” (Certifications, n.d.). Publication: International Journal of Emergency Mental Health. http://www.atss.info/

Federal Emergency Management Agency (FEMA).Under Homeland Security, FEMA is the government agency responsible for managing all phases of disasters from intervention through recovery. Online and certified on-site courses in trauma and disaster are offered including Incident Command System (ICS 100) and National Incident Management System (NIMS 700), often required for participation in state or federal disaster mental health response. Many publications, such as Are You Ready: An In-Depth Guide to Citizen Preparedness. www.fema.gov

Green Cross Academy of Traumatology.The mission ofGreen Cross is to “to accredit training sites throughout the world, to certify traumatologists throughout the world, and to deploy traumatologists when and where requested throughout the world” through the Green Cross Assistance Program. Training and certification include Core/Clinical Traumatologist, Field Traumatologist, and Certified Compassion Fatigue Specialist. No publications listed. www.greencross.org

International Society for Traumatic Stress Studies (ISTSS).ISTSS is an “international multidisciplinary, professional membership organization that promotes advancement and exchange of knowledge about severe stress and trauma. This knowledge includes understanding the scope and consequences of traumatic exposure, preventing traumatic events and ameliorating their consequences, and advocating for the field of traumatic stress” (What Is ISTSS, n.d.). Members are active through Special Interest Groups and the annual conference; ISTSS does not credential individuals. Publications: The Journal of Traumatic Stress, Effective Treatments for PTSD: Practice Guidelines from ISTSS, Childhood Trauma Remembered. www.istss.org

National Voluntary Organizations Active in Disaster (National VOAD).In this forum, national, state, and local organizations share knowledge and resources about the disaster cycle to help communities and disaster survivors. The National Response Framework designated National VOAD and the American Red Cross to represent nongovernmental organizations at FEMA’s National Response Coordinating Center during disaster response. Publications: Disaster Recovery Case Management Standards, Long-Term Recovery Manual. http://www.nvoad.org/

New Jersey Disaster Response Crisis Counselor Certification (DRCC).The state-sponsored DRCC certification’s purpose is to develop a workforce of trained disaster mental health responders “who follow best practice models of intervention” (NJDHS, 2008). Extensive coursework insures “uniformity of screening for competencies necessary for effective crisis counseling, as well as providing a standardized training curriculum for all mental health responders” (NJDHS). Publication: New Jersey Crisis Counselor.www.njdisasterresponsecrisiscounselor.org

Understand the Major Principles of Disaster Response, Trauma Counseling, and Crisis Intervention, and Their Differences

Considerable trauma-related research has been conducted since 9/11. New terms separate victims’ and providers’ experiences into more specific diagnosable and treatable conditions beyond Post- Traumatic Stress Disorder (Figley & Nash, 2007; Uhernik, 2008; Webber, Mascari, Dubi, & Gentry, 2006). New disaster and trauma concepts have emerged such as combat stress injury, psychological first aid (PFA), ICS (Incident Command System), psychological debriefing (PD), critical incident stress debriefing (CISD), critical incident stress management (CISM), vicarious traumatization, compassion fatigue, and compassion satisfaction. This list provides an initial vocabulary to begin expanding curriculum.

Insure That Students Understand Their Ethical Responsibility to Practice Disaster Response and Trauma Counseling Only to the Extent of Their Competence

At the 2007 Argosy University Symposium, Trauma, Tragedy and Crisis, Figley (2007) addressed the needs of massive numbers of veterans suffering from a variety of mental health disorders who will return from Iraq and Afghanistan. Figley cautioned that untrained professionals, while well meaning, could potentially do more harm than good in treating combat veterans. Students must be aware of the ethical and legal responsibilities of licensed professional counselors to practice within their scope of competence.

In addressing ethical considerations in crisis work, Sommers- Flanagan and Sommers-Flanagan (2008) assigned special emphasis to the use of evidence-based practices. Counseling students may benefit from competency-based statements in their curricula that specifically address the ethics of using evidence-based techniques and competencies.

Develop Knowledge and Practice Competencies in Disaster Response, Trauma Counseling, and Crisis Intervention If You Plan to Teach This Specialty in Classes

In addition to theoretical knowledge, counselor educators can develop skills through specialized training experiences, conferences, and additional certifications. Field experiences with multidisciplinary emergency response teams include emergency drills, disaster simulations, tabletop exercises, and volunteering for actual disaster response.

Establish Relationships With Credentialed Disaster and Trauma Specialists With Field Experience Who Are Willing to Be Guest Trainers for Specialized Course Components

Many practicing disaster specialists and traumatologists are willing to share their expertise by teaching topics calling for the demonstration and practice of techniques. Counselor educators can build a network of specialists available for class presentations.

Recognize That Disaster and Trauma Counseling Is a Growing Specialty That Needs Research and Study to Insure Outcome Based Practices

Since 9/11, effective emergency preparedness and disaster response have been the subject of investigation and study. Researchers are developing tools to collect data after disasters, assess survivors’ needs at various stages of recovery, match needs to treatment strategies, and evaluate treatment effectiveness. Counselor educators can engage in research and encourage thesis and dissertation students to investigate issues related to disaster response and trauma counseling.

Continuing to Move Forward

An ancient Japanese proverb tells us that the journey of a thousand miles begins with one step. The adoption of the 2009 CACREP standards is a major step on the journey toward preparing competent counseling graduates to provide disaster and trauma mental health services. While the task of developing and validating model curricula and training practices for disaster and trauma competencies is a work in progress, the counseling profession is in the lead in setting standards.

Table 1

Emergency Preparedness and Response Language included in the 2009 CACREP Standards (CACREP, 2008)

G. Common core curricular experiences and demonstrated knowledge in each of the eight common core curricular areas are required of all students in the program.

1. PROFESSIONAL ORIENTATION AND ETHICAL PRACTICE—studies that provide an understanding of all of the following aspects of professional functioning:

b. professional roles, functions, and relationships with other human service providers, including strategies for interagency/interorganization collaboration and communications;

c. counselors’ roles and responsibilities as members of an interdisciplinary emergency management response team during a local, regional, or national crisis, disaster or other trauma-causing event;

d, self-care strategies appropriate to the counselor role;

3. HUMAN GROWTH AND DEVELOPMENT—studies that provide an understanding of the nature and needs of persons at all developmental levels and in multicultural contexts, including all of the following:

c. effects of crises, disasters, and other trauma-causing events on persons of all ages;

d. theories and models of individual, cultural, couple, family, and community resilience;

f. human behavior, including an understanding of developmental crises, disability, psychopathology, and situational and environmental factors that affect both normal and abnormal behavior;

5. HELPING RELATIONSHIPS—studies that provide an understanding of the counseling process in a multicultural society, including all of the following:

g. crisis intervention and suicide prevention models, including the use of psychological first aid strategies.

Addiction Counseling

Understands the impact of crises, disasters, and other trauma- causing events on persons with addictions.

Understands the operation of an emergency management system within addiction agencies and in the community.

Understands the principles of intervention for persons with addictions during times of crises, disasters, and other trauma- causing events.

Career Counseling

Understands the impact of crises, emergencies, and disasters on a person’s career planning and development.

Clinical Mental Health Counseling

Understands the impact of crises, disasters, and other trauma- causing events on people.

Understands the operation of an emergency management system within clinical mental health agencies and in the community.

Understands the principles of crisis intervention for people during crises, disasters, and other trauma-causing events.

Understands appropriate use of diagnosis during a crisis, disaster, or other trauma-causing event.

Differentiates between diagnosis and developmentally appropriate reactions during crises, disasters, and other trauma-causing events.

Marriage, Couple and Family Counseling

Understands the impact of crises, disasters, and other trauma- causing events on marriages, couples, families, and households

Understands the impact of addiction, trauma, psychopharmacology, physical and mental health, wellness, and illness on marriage, couple, and family functioning

School Counseling

Understands the operation of the school emergency management plan and the roles and responsibilities of the school counselor during crises, disasters, and other trauma- causing events.

Understands the potential impact of crises, emergencies, and disasters on students, educators, and schools, and knows the skills needed for crisis intervention.

Knows school and community collaboration models for crisis/disaster preparedness and response.

Student Affairs and College Counseling

Understands the impact of crises, disasters, and other trauma- causing events on people in the postsecondary education community.

Understands the operation of the institution’s emergency management plan and the roles of student affairs professionals and counselors in postsecondary education during crises, disasters, and other trauma-causing events.

Demonstrates an understanding of the psychological impact of crises, disasters, and other trauma-causing events on students, faculty, and institutions.

Understands the principles of intervention for people in the learning community during times of crises and disasters in postsecondary education.

Demonstrates skills in helping postsecondary students cope with personal and interpersonal problems, as well as skills in crisis intervention in response to personal, educational, and community crises.

Doctoral Standards

Theories pertaining to the principles and practice of counseling, career development, group work, systems, consultation, and crises, disasters, and other trauma causing events.

Understands the effectiveness of models and treatment strategies of crises, disasters, and other trauma-causing events.

Understands models, leadership roles, and strategies for responding to community, national, and international crises and disasters.