Implementation of a Multi-Phase, Trauma-Focused Intervention Model Post-Hurricane Maria in Puerto Rico: Lessons Learned from the Field Using a Community Based Participatory Approach

Abstract

Hurricane Maria made landfall in Puerto Rico on September 20, 2017, becoming the most devastating storm to impact the island in almost a century. Natural disasters have been shown to adversely impact children’s emotional, behavioral, and academic functioning and schools provide an ideal setting in which to implement wide-reaching interventions that can bolster resiliency and promote psychological recovery. Yet there is limited-to-non existent literature describing the actual implementation process of an evidence-based, trauma-informed intervention model within a school system after a natural disaster. This paper describes the process by which our team established a partnership with the Puerto Rico Department of Education (PR-DE) to implement the Puerto Rico Outreach Model in Schools-Esperanza (PROMISE), beginning shortly after Hurricane Maria made landfall. We describe our multi-phase, trauma-focused intervention model implemented with Puerto Rico school personnel using a Community Based Participatory Approach. PROMISE included 3 phases: 1) Phase 1 (three weeks post-hurricane): Providing Psychological First Aid training for school teachers and staff to meet the needs of all students affected by the hurricane through classroom-based intervention; 2) Phase 2 (six months post-hurricane): Providing Skills for Psychological Recovery training for school social workers and psychologists to meet the needs of students with sub-clinical trauma-related concerns and; 3) Phase 3 (one year post- hurricane): Providing Trauma-Focused Cognitive Behavioral Therapy training for school psychologists to address higher level and unremitting trauma-related symptoms in students. We describe the process by which key partnerships were established, the step-by-step implementation process of each phase, lessons learned from the field, and implications for practice, training, policy, and future research.