Assisting rural employees following critical events: businesses in rural areas can help employees recover from traumatic incidents by building on local social networks, educating workers about post-disaster stress, and coordinating with community organizations.

Following natural disasters, terrorist attacks, or episodes of workplace violence, many people experience significant stressors, including economic loss, loss of life, and family conflict, and psychological reactions such as depression, anger, and anxiety In the workplace, these stressors and reactions may lead to reduced productivity, missed workdays, conflict between employees, low morale, and concerns about job security.

Although these reactions are common to people living and working in all geographic and social environments, individuals and businesses in rural communities face unique challenges during the recovery process. Because of their remote locations and limited resources, rural communities recover from disasters quite differently than do urban communities (Stamm 2002).

Rural America represents a significant demographic in the United States--approximately four-fifths of U.S. land is classified as rural, and nearly 60 million Americans (roughly 20 percent) live in rural communities--but a disadvantaged one as well. Its residents are more likely to experience economic hardship and poverty, have unmet health care needs, and lack insurance, each of which can impede recovery from disasters (Rost, Fortney, and Smith 2002).

In addition, although rates of mental health disorders are generally the same for rural and urban residents (Rost et al. 2002), residents of rural areas often encounter barriers to accessing mental health treatment. These barriers include fewer mental health providers in rural areas (e.g., fewer than 20 percent of the most rural counties have mental health providers), a lack of specialty services such as child psychology, the need to travel long distances to receive care, inadequate insurance coverage for mental health, and rural social stigmas that dissuade community members from seeking help for mental health-related concerns (Center for Mental Health Services 1997; Holzer, Goldsmith, and Ciarlo 2000; National Rural Health Association 1999; Office of Rural Health Policy 2002).

As a result, in many rural areas, primary care doctors serve as a mental health resource for their patients. If the need for mental health services arises, as it does following disasters and other community tragedies, barriers to mental health care in rural areas can be magnified and can impede community-wide psychological recovery.

Traditional rural values may also affect recovery from traumatic incidents. People in rural communities may prefer talking to local providers and trusted community members and often form a "trauma membrane" after critical events that may be hard to penetrate (Lindy 1985). Outside agencies and professionals may find it difficult to be accepted, as residents may question whether these people share their values, understand their way of life, or know what is good for them.

In addition, rural residents may fear being stigmatized if they seek help for stress and may be reluctant to accept assistance. Seeking help may be seen as a weakness among rural residents, who often pride themselves in being self-sufficient. Employers in rural areas should consider what resources they can provide for their employees after a critical event, as employees may find it easier to accept and seek help from someone they know and trust than from people outside the community.

HELPING EMPLOYEES

One resource that businesses in rural communities can draw upon is the presence of close-knit family and community social networks. Social support for affected individuals is an important aspect of recovery following critical events (Barling et al. 2002), and many rural residents have close ties to people in their communities, neighborhoods, and workplaces (Jackson and Cook 1999).

Rural employers also can help organize interested employees to assist in business or community recovery efforts, which can provide workers with a feeling of control over their recovery Fostering a sense of control over recovery is especially important following terrorist events or workplace violence, as employees may perceive they have less control in these situations (Barfing et al. 2002). Sponsoring business or community meetings where people can come together over a meal to discuss recovery plans and efforts, as well as gain support, can also be helpful.

It is vitally important to educate employees about the emotional and psychological symptoms associated with critical events so they will be able to recognize if they are experiencing post-traumatic stress and know how to get assistance. Providing handouts or information on a Website about the mental health impacts of critical events, stress management strategies, and resources for accessing help can help educate workers. Examples of such handouts can be found on the Employee Assistance Professionals Association's Website.

It is also important to monitor employees over the long term and speak with them if you sense they are struggling with their reactions to a critical event. Workers in small businesses often know each other well, which may make it easier for them to recognize when a fellow employee is struggling and speak with them about getting help.

Since many employees of small rural businesses lack health insurance that includes coverage for mental health expenses, rural businesses should make plans to address these needs through EAPs. For rural businesses that lack the EAP structures present in larger companies, it is important to identify alternative mental health resources in the local community (including community mental health centers and faith-based counseling services).

Addressing the stigma associated with seeking mental health services is very important in rural communities. Employers should work to decrease employees' concerns that seeking help might affect their jobs (especially in fields such as emergency response and law enforcement) as well as persuade workers that stress symptoms are normal after critical events and that accepting assistance is a healthy decision. One way to increase the number of employees reached is to offer services for spouses, partners, and children, as some people may be more likely to seek help for family members than for themselves. By providing services for family members, you may be able to indirectly reach an employee who needs help.

If a business sustains damage or loses employees because of a disaster or incident, workers understandably will be concerned about the future of their jobs. Employers should consider assisting employees with finding alternative .job placements if they cannot keep their businesses open after a disaster (Jackson and Cook 1999).

Finally, it is important that rural business managers and leaders take care of themselves and attend to their personal emotional needs following a critical event. They will be called upon to provide support for their employees, perhaps more so than would be the case for urban business leaders.

UTILIZING LOCAL RESOURCES

In addition to drawing upon their own resources, rural businesses can coordinate with local community groups and providers to assist their employees and communities following critical events. In rural areas, working with local resources that are already seen as trustworthy may be vital to reaching the greatest number of affected employees and community members. Local resources can include indigenous helpers, religious groups, organizations such as the Kiwanis, Jaycees, or Rotary clubs, the local chapter of the American Red Cross or the Salvation Army, and schools. Local religious organizations often assist in disaster recovery, and clergy members can provide comfort and counsel as well as help guide people to available community resources.

The local school system can be a good resource for employees who have school-aged children. School personnel can provide support for children and their families and can serve as a gateway to referrals for further assistance.

A frequently overlooked resource in rural areas is the Cooperative Extension Service. Following Hurricanes Katrina and Rita in 2005, Extension professionals in the affected Gulf Coast states were involved in multiple aspects of disaster recovery, especially in rural areas. Cooperative Extension is a key resource in rural counties, as Extension agents are located in the communities they serve and have personal knowledge of the area and the residents, making them a great resource for disseminating information about disaster preparation and recovery.

Extension agents are often closely linked with specific community segments (e.g., farmers) and are thus not viewed as outsiders. As a result, community members may feel that they can relate easier to Extension agents, as trust has already been established. The Extension Disaster Education Network (EDEN) is an excellent resource for connecting with Extension professionals who have experience planning for, and responding to, disasters. For more information, visit EDEN on the Web at www.eden.lsu.edu.

DEVELOPING A DISASTER PLAN

As with all elements of disaster planning, establishing relationships with community organizations should be conducted prior to a critical event. The immediate aftermath of a disaster or other traumatic incident can be chaotic and stressful, which may lead to missed opportunities or difficulties in coordination.

Employers should be careful to develop a disaster plan that covers many different types of critical events. The U.S. Department of Homeland Security and EDEN have developed "Ready Business: A Guide to Preparing a Business Disaster Plan," which applies to businesses of all sizes. Interested employers can contact their state EDEN delegates (on the Web at www.eden.lsu.edu/AboutEDEN/State_Contacts.aspx) for more information. Additional disaster planning materials for employers are available at www.ready.gov/business/index.html.

Planning assistance for specific events is also available via the Internet. For example, the Centers for Disease Control and Prevention has posted a checklist to help businesses prepare for a flu pandemic. The checklist is available at www.pandemicflu.gov/plan/pdf/businesschecklist.pdf.

As part of their overall disaster plan, rural employers should include strategies for meeting the mental health needs of employees following critical events. For example, plans should address how the EAP will respond to events and collaborate with community mental health resources if needed. If companies do not have an EAR they can develop a list of local mental health resources and support networks that can be accessed following an event.

Ideally, disaster plans should include provisions for helping employees locate and obtain help for spouses and children. Employers might also consider whether they can provide financial assistance to employees whose insurance does not cover mental health treatment.

Staff from the National Rural Behavioral Health Center at the University of Florida have developed a curriculum based on their experiences assisting communities following disasters. The curriculum, Triumph Over Tragedy, Second Edition: A Community Response to Managing Trauma in Times of Disaster and Terrorism, describes strategies for assisting individuals and communities responding to the mental health impacts of natural and human-caused disasters. Rural businesses may find the curriculum helpful for both disaster planning and response, especially with regard to responding to employee mental health needs. For further information, visit www.nrbhc.org and follow" the links for "Rural Disaster and Trauma."

References

Barling, J., J. Hurrell, M Braverman, J. Collins, M. Gelles, and E. Scrivner. 2002. Terrorized workers: Employee well-being following 9/11. APA Task Force on Workplace Violence. Washington, D.C.: American Psychological Association.

Center for Mental Health Services. 1997. Mental health providers in rural and isolated areas. Publication No. SMA 98-3166. Washington, D.C.: U.S. Department of Health and Human Services.

Holzer, C.E., H.F. Goldsmith, and J.A. Ciarlo. 2000. The availability of health and mental health providers by population density. Journal of the Washington Academy of Sciences 86(3): 25-33.

Jackson, G., and C.G. Cook. 1999. Disaster mental health: Crisis counseling programs for the rural community. Publication No. SMA 99-3378. Washington, D.C.: U.S. Department of Health and Human Services.

Lindy, J. 1985. The trauma membrane and other clinical concepts derived from psychotherapeutic work with the survivors of natural disasters. Psychiatric Annals 15: 153-160.

National Rural Health Association. 1999. Mental health in rural America. Kansas City. Mo.: National Rural Health Association.

Office of Rural Health Policy 2002. Rural communities and emergency preparedness. Washington D.C.: U.5. Dept. of Health and Human Services.

Rost, K., J. Fortney, and J. Smith. 2002. Use, quality, and outcomes of care for mental health: The rural perspective. Medical Care Research and Review 59: 231-265.

Stamm, B.H. 2002. Terrorism risks in rural and frontier America: Their importance to the successful functioning of urban America makes rural and frontier areas ripe targets for terrorism. IEEE Engineering in Medicine and Biology 21(5): 100-111.

Brenda A. Wiens, Ph.D., and Ronald H. Rozensky, ABPP 

Brenda Wiens is a research assistant professor in the Department of Clinical and Health Psychology and the National Rural Behavioral Health Center at the University of Florida. She co-edited the curriculum, Triumph Over Tragedy (2nd edition): A Community Response to Managing Trauma in Times of Disaster and Terrorism, and has conducted trainings using this curriculum. She can be reached at [e-mail].

Ron Rozensky is a professor in, and chair of, the Department of Clinical and Health Psychology in the College of Public Health and Health Professions at the University of Florida. He is founding and cur rent editor of the Journal of Clinical Psychology in Medical Settings and was the principal investigator of a grant from the Substance Abuse and Mental Health Services Administration that helped found the National Rural Behavioral Health Center.