Reduction of stress and trauma in the delivery of disaster

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					                Reduction of stress and trauma in the
                delivery of disaster recovery services:
                   The users decide—an exploratory study of the effects of
                            delivering disaster recovery services

     Background                                                                                         developing changes in service strategies
     Storms and flooding which occurred                                                                 to offset this approach is supported by
                                                         by Dawn Juratowitch, Queensland,
     suddenly and without warning on the                                                                McMillen & Fisher (1998). In developing
                                                        State Disaster Recovery Coordinator,
     night of 9th March 2001 affected a number                                                          a scale to measure beneficial life changes
     of locations in south east Queensland             K. L. Daly, Senior Project Officer in the        after negative life events, they draw on a
     including parts of Brisbane, Sunshine             Disaster Recovery Unit, Department of            body of literature which shows that
     Coast, Gold Coast, Caboolture and Logan,          Families, Queensland and N. J. Smith,            negative disasters ‘...natural, technological
     and disrupted the lives of many people. It        formerly Dean and Professor of Social            and criminal...’ (McMillen & Fisher, 1998
     resulted in the deaths of two people. More        Work at the University of Queensland.            p. 173) sometimes generate positive
     than 500 individuals and families sought                                                           psychosocial life style benefits. Two
                                                           The paper was presented to the
     help from the Department of Families,                                                              examples of these benefits are ‘...more faith
     and many more approached other agen-                 Australian Critical Incident Stress           in people...’ and ‘...a sense of of neigh-
     cies. There is little evidence in the             Association Conference Trauma Across             borhood closeness...’.
     literature of consumer feedback on the           Cultures in Brisbane on August 4, 2001.             If this is the case, then it is important
     quality of disaster recovery services, in                                                          to learn when, and to whom this occurs,
     particular how promptly services are                                                               since it may well be valuable in the
     delivered and how appropriate these                                                                development of intervention training for
     services are following such events.            as well as a need to learn more about the           disaster recovery staff. It could help us to
        Therefore it was decided to focus an        research issues confronting any future              reassess our concept of how services are
     exploratory research project on those          work in this area.                                  delivered: more positive skill enhance-
     people who had received financial relief          Finally, to begin examining disaster             ment based on self-learning principles (as
     assistance paid under the Natural Disaster     recovery experiences from the perspec-              opposed to didactic instructional mate-
     Relief Assistance scheme (NDRA), and           tive of what actually helps people affected         rial), which could be made available with
     had interacted on a personal level with        by the disaster event to develop resilience,        other information before and imme-
     Department of Families staff following the     and how this knowledge can lead to                  diately after a disaster.
     above storm. As NDRA relief payments           ensuring better prepared communities                  It is therefore important that we learn
     are means tested and have specific             with increased capacities to deal with              ways of how to best research the provision
     eligibility criteria, the group selected was   possible disaster events. Overall, the study        of assistance following a disaster. The
     in effect a sub-group of the total of those    arose from a commitment to build the                people affected are not a homogenous
     sustaining material loss as a result of the    knowledge base in disaster recovery to              group, they may be only temporary
     storm.                                         ensure best practice.                               incapacitated by the ‘event’, but it may be
                                                       From a brief review of literature, there         traumatic enough to affect memory of
     Introduction                                   is little reported on support given to              what services were provided, by whom
     The idea for this research emanated from       individuals following a disaster, and in            and when. These are all-important factors
     three sources.                                 particular their response to the event in           in evaluating service delivery and the
       Firstly, a desire to obtain feedback from    terms of lifestyle changes and personal             planning and provision of future services.
     consumers as to the effectiveness and          reaction. Specifically in this context,
     efficiency of the disaster recovery services   Buckle’s work (1998, 1999, 2000) is the most        Methodology
     they received from the Department of           geographically relevant and recent contri-          In undertaking the study it was decided,
     Families during the 9 March 2001 storms        bution. In particular, his work on rede-            using a sampling method, to examine the
     and floods. This is in keeping with the        fining the concepts of ‘community’ and              perceptions of some of the people
     Department’s policy of continuous              ‘vulnerability’ offers much in helping us           affected in relation to their experience of
     service improvement. It also reflects a        to change the current welfare orientation           service provision. In addition an attempt
     commitment to the development of a             of some of our service delivery strategies.         was made to assess if, after the event,
     strong evidence base for policy and            The present approach traditionally sees             problems still persisted. It was also
     practice, and acknowledges that con-           the recipient of a service as ‘dependent’           planned to gather individuals’ recollections
     sumer evaluation is essential to both.         and of limited ‘functioning ability’, and           of the event and the impact the storm
       Secondly, a need to establish a valid and    reliant on external ‘specialist’ service            had had on them. Because of the differen-
     reliable instrument that could be used         providers who are the experts in deter-             tial nature of the damage to property and
     following disaster events to regularly         mining what is best for the recipient. That         the varied intensity of the storm within
     monitor the quality of service provision,      another perspective can be entertained in           the geographical area, it was decided to

50                                                                                                 Australian Journal of Emergency Management
obtain a purposive sample taking these           the community’; ‘I have learned how                     Following design of the data collection
factors into account.                            good people can be’.                                  instrument and its pre-study testing, it
                                                                                                       was recognised that time restraints would
Instrument                                       Sample                                                limit sample size, since it was decided that
A personally administered questionnaire          The sample was taken from those people                the nature of the study required personal
was used, since it was recognised that           who had been visited by staff of the                  interviews. It was estimated it would take
respondents would probably need to               Department of Families and paid emer-                 at least 40 minutes to engage and debrief
ventilate their experiences relating to the      gent, household contents or structural                the respondent and administer the
storm and its consequences. Also, since          repair relief assistance. To qualify for such         questionnaire. It was also found that
this was an exploratory pilot study in           payment, these applicants had been assets             tracing and contacting respondents,
order to develop a more comprehensive            and means tested, and were not covered                obtaining agreement and visiting to
data collection instrument for future use,       by insurance. At the time the study was               interview further complicated the data
it was felt this approach was more               commenced, there had been payments                    collection process.
appropriate. Open-ended questions were           made to 272 individuals/families who had                In fact, 140 telephone calls were needed
designed, pre-tested and modified. These         experienced some material losses in the               to obtain the final number of 40 respon-
related to the service requested, when           areas affected by the flooding.                       dents. A number of people in the popu-
received and from whom. Overall mea-                Initially it was decided to undertake a            lation from which the sample was drawn
sures of satisfaction were gained and            20% random sample covering all storm-                 had no telephone, several had moved
opinions sought as to what changes to            affected areas, however, a number of                  away, and 25 numbers were disconnected.
service provision would be advantageous,         considerations changed this decision. As              As calls were made during the day, many
including the kind and form of informa-          it was decided to attempt to obtain                   potential interviewees were at work, and
tion needed before and after similar             respondents from different ethnic and                 thus not contactable: this factor would
disaster events.                                 cultural groups, and as this distinction              have influenced the high proportion of
   In addition to basic socio-economic           was not immediately obvious from the                  those sampled who were recipients of
data, including country of birth etc, two        source data to hand, it was decided that a            Centrelink benefits. There was only one
additional sections were included. These         purposive sample would be needed.                     refusal to cooperate with the study.
related to psychological and physical               Secondly, because of the geographical                One staff member conducted the
behaviours before and after the storm,           pattern of the storm’s path and the                   majority of interviews over a three-week
and the extent to which the incident had         consequence that some areas were more                 period.
changed the respondent’s experiences             adversely affected than others, it was
concerning personal and social contacts.         recognised that socio-economic factors                Results
   The first section was explored with a         in those affected areas indicated the                 The 40 respondents had endured flood
simple questionnaire used in the Cham-           possibility of potential significant social           damage and the sample covered 15
berlain et al (1974) study after the Darwin      difficulties for those involved which                 different suburbs. Table 1 shows the
Cyclone. This asked whether certain              warranted further examination/analysis.               characteristics of the sample.
physical and psychological behaviours               Thirdly, because of the range of pre-                The range of requests for help per
existed before the storm and whether             mises affected by the storm, it was                   respondent was between 0 and 7 with a
these persisted after. A scoring system of       decided that it was necessary to include a            mean of 2.95. Table 2 gives the breakdown
1-6, with 1 indicating no evidence of            sample of houses, flats and caravans. From            according to the type of assistance
behaviour and 6 indicating a very strong         this, a sample framework was drawn up                 requested.
positive change of the behaviour since           to include the above factors, with the                  It can be seen that the largest category
the storm, was used.                             original aim to sample 60 people.                     was for financial assistance. This was
   The second set of questions arose from
the work of McMillen & Fisher (1998)
into the perceived positive life changes
                                                      Summary of Sample Characteristics (Sample N=40)
experienced after negative events. Their
work, based on literature which indicates             Respondents                                      Male                  45.0%
                                                                                                       Female                55.0%
that people often report benefits from
negative events they have experienced,                Dwelling                                         House                 80%
                                                                                                       Flat                  15%
developed a scale with 8 sub-scales, which                                                             Caravan               5%
explores the effect a nominated event has
                                                      Moved from premises                              permanent             10%
had on a person’s life. For example, its              as a result of the damage                        temporary             27.5 %
effect on the persons perception of their
                                                      Place of birth                                   Australia             60%
‘faith in people’, ‘lifestyle changes’ or                                                              UK & NZ born          17.5%
‘increased community closeness’. It was                                                                Aboriginal            2.5%
decided to test a small number of the sub-                                                             Remainder             15.0%
scales and four were subsequently chosen.             First Language                                   non-English           15%
These were ‘increased community close-                Half of the respondents lived in a family setting with some member disabled
ness’, ‘family closeness’, ‘lifestyle changes’
                                                      Age range 23-80 years with mean age of 47.5 and median age of 43
and ‘faith in people’. The questions
attempted to ascertain the strength of                Single, or single with dependents                57.5%
agreement or disagreement with state-                 Over 57% of the sample were receiving some form of pension
ments relating to the respondent’s feelings
since the storm e.g. ‘I feel more a part of      Table 1: Summary of sample characteristics.

Autumn 2002                                                                                                                                           51
                                                                                                                       For many this was another crisis in
          Item                                                              F                  %                    their lives that set them back financially
          Clothing                                                          6                  5.2                  and 3.5 months later they were still
          Food                                                              7                  6.1                  struggling. Many people from the sample
                                                                                                                    were also coping with other major
          Furniture/household goods                                        16                  13.9
                                                                                                                    problems at this time e.g. marital break-
          Help with cleaning up                                            15                  13.0                 down, serious illness. Most are still
          Elec check                                                       12                  10.4                 traumatised at times of heavy clouds and
          Health needs                                                      4                  3.5                  forecast of rain. Actual rainstorms make
          Personal counselling                                              4                  3.5                  many people extremely anxious. Some
          Information                                                      10                  8.7
                                                                                                                    parents reported children having sleep
                                                                                                                    problems or nightmares, which they
          Financial help                                                   37                  32.2
                                                                                                                    attribute directly to experiences during
          Other                                                             4                  3.5                  the storm.
          Total                                                            115                 100.0                   Many of the subjects in this study spoke
          ( Based on multiple number of responses, not respondents)                                                 of experiencing high levels of individual
                                                                                                                    trauma and were very frightened through-
     Table 2: Number of requests for help.                                                                          out the time of the flooding. None ini-
                                                                                                                    tiated personal counselling, nor did they
     followed by requests for furniture and                           and ‘warm’, giving ‘practical help’. They     largely perceive a need to do so. Many
     household goods and then help with                               tended to view the Department as the          related stories of emotional debilitation
     cleaning up after the storm. 48.8% of                            preferred agency for future problems,         and some indicated a deterioration in
     respondents received more help than                              irrespective of the problem.                  their level of daily functioning, which they
     requested, while fewer than 25% received                            Positive comments were made regar-         directly attributed to the emotional
     just the help they had requested. For the                        ding Members of Parliament and Local          effects of the storm.
     remainder, it should be noted that NDRA                          Authority Councillors who had visited the        In order to see if there were differences
     guidelines enable the Department of                              area, although the perceived range of help    in reaction to the effects on the families,
     Families to provide financial help, rather                       offered by the different Councils varied,     that might be influenced by cultural or
     than actual material goods. Although                             often within the one local Council area.      ethnic factors, the responses of those not
     people may have requested material                                  Concern was raised over situations that    born in Australia and the respondent with
     goods e.g. clothing or furniture, the                            give rise to flooding, for example the        an Aboriginal background, were com-
     Department provided financial help to                            building of houses on flood plains,           pared with those who identified as being
     purchase these items through other                               construction of busways, the construction     Australian born. Since the total number
     sources such as non-government agen-                             of golf courses across streams and the        of respondents was only 40, and this is the
     cies, or they received such help from                            ongoing work on creek channelling. Real       least possible number tolerated in some
     family and friends.                                              Estate Agents and landlords were criticised   statistical procedures, it was decided to
        From their answers to the questions,                          for not advising that rented property was     make general observations regarding this
     85% of respondents said they were visited                        in flood prone areas, and the Weather         comparison rather than analysing it
     by Department of Families staff and                              Bureau received widespread criticism for      statistically.
     applied for assistance within a week of                          its failure to provide adequate warnings         Overall, in examining the data, there
     the storm, with 25% of those being visited                       of heavy rain and likely consequent           were no obvious differences that could
     and requesting assistance within two days                        flooding.                                     be explained specifically by ethnic and
     of the storm.                                                       Interviewees were mostly unable to         cultural factors. The only difference that
        In all, 95% of the sample had requested                       distinguish between information that          was identified related to temporary
     assistance within 10 days of the storm,                          needed to be provided before an event         moves after the flood, with more non-
     with 85% having received financial                               and help required immediately after it.       Australian born taking this step.
     assistance within 10 days of their request.                      Most had no idea of available services in        When responses to the 20 questions
     The median time for respondents reques-                          the community and they were unable to         forming the questionnaire from the
     ting assistance was 4 days after the storm,                      provide any clear ideas as to what assis-     Darwin Cyclone study were analysed
     and the median time to receive assistance                        tance might help them. Some made              using cluster analysis, five distinct and
     was 2 days after the request.                                    suggestions regarding the form that           coherent clusters emerged. These related
        Generally respondents were unsure                             information could take, for example the       to relationships e.g. with family, children
     where the assistance they received was                           provision of fridge magnets, a brochure       spouse etc.; indicators of a gastro-
     from, but could provide details with                             distributed with electricity bills, a bro-    somatic origin e.g. troubled by indi-
     prompting. Likewise, they had difficulty                         chure hand delivered after the event, and     gestion, bowel complaints; psycho-
     in recalling who had had actually visited                        details of relevant assisting agencies in     endogenous e.g. nervous and depressed,
     them, other than staff from the Depart-                          local newspapers, and on radio/TV             restless, lacking in confidence; psycho-
     ment of Families. This was not influenced                        advertisements. Most respondents saw          exogenous e.g. skin complaint, asthmatic;
     by age, since the range was from 23 to 80                        avenues of help as the ‘big picture’          and finally Alcohol Related.
     years, with a mean of 47.5 years. Almost                         approach e.g. changes to channelling,            When the questions were examined by
     exclusively and spontaneously, the res-                          curbing, drains etc rather than at an         averaging responses according to the
     ponse regarding the Department of                                individual level, such as preparation for     above groups, overall 60-62% reported no
     Families was positive, and respondents                           evacuation, awareness of helping agencies,    changes before or after the storm. That is,
     saw the workers as ‘caring’‘understanding’                       list of phone numbers near the phone.         the phenomenon was not present before

52                                                                                                             Australian Journal of Emergency Management
or after the storm, or if it was present           A picture has emerged, however, of           the random nature of the effects of a
before the storm there had been no              people who are often in the midst of crisis     disaster, not all people are necessarily
change in severity after the event. A small     at the time of sustaining a disaster event.     seriously affected by the event, and may
number (2-3%) indicated the signs were          Whilst from a service provision perspec-        not identify with the aims of a research
present before the storm and were worse         tive, the disaster is the principal focus,      project.
now. Between 25-30% indicated the               for some recipients it is one more                In addition, since the focus is on the
presence of symptoms before the storm           difficulty at this time in their life to deal   adequacy of ‘service provision’, only those
with slight improvements in the symp-           with. For some, an attitude of fortitude,       people eligible to receive this service, in
toms now. This was marked in those              inevitability, resignation and an ability to    this case monetary assistance, were
symptoms which could be grouped as              fight back assist them to deal with this. A     identifiable for inclusion in the study.
Psycho endogenous in origin.                    focus on the ‘whole situation’ rather than      Many useful ideas regarding service
   However, when examining the data             the restitution of material goods might         provision in community recovery may
according to individual responses across        provide a useful ‘starting point’ in the        have been proffered by those similarly
all the questions, forty five percent (17)      initiation of community disaster re-            affected by the event, but not targeted,
marked between 1 to 9 of the questions          covery. Disasters are no respecter of           given the exclusivity (on general financial
indicating deterioration, while 22.5%           persons or type of property, and geo-           grounds) of the chosen sample. Further-
reported an improvement. Of those               graphical and environmental factors are         more, an alternative sample might have
indicating deterioration, this was in regard    seen by the respondents to be of major          highlighted individual aspects of resili-
to being now more worried about the             concern to them. Policy makers in the area      ence peculiar to this latter group. Such
future (Question 2) and now being more          of flood mitigation need to ensure they         information could assist us in the pro-
nervous and depressed (Question 4).             provide open access to residents such that      vision of resources to those already facing
   When the results were examined in            their experiences can influence decisions       other difficulties in their lives, where
relation to ethnic or cultural origins there    made regarding environmental changes            coping with the effects of a natural
were no significant differences, although       in flood prone areas.                           disaster is one more hurdle to overcome.
there was a trend for more non-Australian          There is some evidence emerging              Work is now in process planning to
born respondents to report symptoms             which indicates that some positive              compare the results from this study with
that were grouped in the psycho exoge-          aspects can arise from a disaster, such as      those from a group who did not qualify
nous cluster.                                   a stronger faith in people and a stronger       for the NDRA assistance, but who live in
   With regard to the Perceived Benefit         sense of community. These are factors           the same geographical areas.
Scale, the results of this small pilot study    that should be remembered and imple-              Secondly, timing of these kinds of
showed that between 75% and 85% of              mented in staff training programs.              studies is important. If undertaken too
respondents felt there had been no change          The service offered to respondents by        soon after the event, respondents may still
in relation to ‘lifestyle changes’, ‘com-       the Department of Families concentrated         be in a state of shock and focused on
munity closeness’ or ‘family closeness’.        primarily on financial assistance to            solving associated problems. If under-
However, with regard to the sub-scale           replace material losses. Whilst most            taken too long after the event, memory
referring to ‘increased faith in people’,       respondents were extremely positive             may play a part in confusing recall, or
70% agreed or strongly agreed with an           about the services provided, this study         minimise the effect of certain factors. In
increase in this indicator. Bearing in mind     has indicated a need for attention to an        either case, what is important is to
the general reports earlier that respon-        holistic approach in service delivery, and      undertake studies that allow respondents
dents appreciated the care and attention        refinement of referral to and coordination      to answer in their own terms. This not
of workers from Family Services, this           of assistance offered by other community        only allows them to ventilate their feelings
result is a possible reflection of that.        agencies.                                       about the event, but also focuses them on
   When the results were examined for              With regards to feedback, people are         the topic being researched. It also allows
possible differences according to eth-          generally interested in being asked about       them to contribute additional anecdotal
nicity or culture, no differences were          their experiences and have the right to         material which may, through analysis,
found.                                          see the results of their endeavours in          prove of interest and importance to the
                                                feedback about the research. At this stage,     research undertaken.
Discussion                                      the manner whereby those interviewed              It is recognised that the questions used
Discussion of these findings will be dealt      will be provided with feedback is yet to        in this study need refining, and, given the
with briefly in two parts: firstly the actual   be determined; however, it is envisaged         background details of the respondents,
results, and secondly matters relating to       that all will be contacted by mail shortly      many had difficulty in understanding
further research into this area.                and provided with a succinct outline of         what was required. As this was in fact a
  In view of the apparent scant attention       the questionnaire analysis.                     pilot study to further research, it is felt
paid to this particular aspect of disaster         The process of researching this area         the questions were adequate for the
recovery in Australia, this was essentially     brought the following matters to light.         purpose and, as primarily one interviewer
an exploratory exercise. It has revealed a         Firstly, while it is desirable to ensure a   was used, any variation from the written
clear picture of satisfaction with the          probability sample of sufficient size to        questions was consistent, and did not
services provided by the Department of          be able to draw strong inferences, this may     influence the data results.
Families and their timing. From the             not be possible in populations affected
sample, there does not appear to be any         by disaster events. Temporary or perma-         References
specific area which is influenced by            nent moves, property destruction and            Buckle P., Brown J. & Dickinson M. 1998,
ethnicity or culture, and there are no          damage to telephone services or discon-         ‘Supporting the Entire Person’, Australian
apparent indicators for a revision of           nection may prevent access to those             Journal of Emergency Management,
services along ethnic/cultural lines.           people affected. In addition, because of        Winter, Vol. 13, No. 2, pp. 35–38.

Autumn 2002                                                                                                                                    53
       Buckle P. 1998/99, ‘Re-defining Com-         Perceived Benefit Scales: Measuring            a Senior Project Officer in the Disaster
     munity and Vulnerability in the Context of     perceived positive life changes after          Recovery Unit, Department of Families,
     Emergency Management’, Australian              negative events’, Social Work Research Vol.    Queensland.
     Journal of Emergency Management, Sum-          22, No. 3, pp. 129–192.                          Norman J Smith PhD. M.A. Dip Mental
     mer, Vol. 14, No. 4, pp. 21–26.                                                               Health, MAASW was formerly Dean and
       Buckle P., Mars G. & Smale S. 2000, ‘New     About the authors                              Professor of Social Work at the University
     Approaches to Assessing Vulnerability          Dawn M Juratowitch B.A. B.S.W. MAASW           of Queensland. He is the author of a
     and Resilience’, Australian Journal of         has extensive senior management expe-          number of books and papers on research
     Emergency Management, Winter, Vol. 15,         rience in the public and university sector.    methodologies, physical disability and the
     No. 2, pp. 8–15.                               She has presented papers and published         application of Information Technology in
       Chamberlain E. R. 1981, ‘The experience      in the area of foster care and management.     Human Services.
     of Cyclone Tracy’, A.G.P.S., Canberra, 1981,   Currently she is the State Disaster
                                                                                                   Authors contact details
     instrument discussed in The Preventive         Recovery Coordinator for the department
                                                                                                   Dawn Juratowitch, Queensland
     Psychiatry of Natural Hazard, ed. Raphael,     of Families, Queensland.
                                                                                                   State Disaster Recovery Coordinator,
     B., paper presented at Symposium on              Kerry L Daly B.S.W has worked as a
                                                                                                   Department of Families
     Natural hazards, Canberra, May 26-29           social worker in the public and private
     1976.                                          sector and has experience in research in
        McMillen J.C & Fisher R. H. 1998, ‘The      the area of grief and loss. She is currently      This article has been refereed

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54                                                                                            Australian Journal of Emergency Management

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