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Caring for the Harvest Force in Crisis Situations

by Robert Klamser, Executive Director, CCI

INTRODUCTION

Then he said to his disciples, “The harvest is plentiful but the workers are few.”[i]

I am sending you out like sheep among wolves.  Therefore be as shrewd as snakes and as innocent as doves.[ii]

I have worked much harder, been in prison more frequently, been flogged more severely, and been exposed to death again and again … I have been in danger from rivers, in danger from bandits, in danger from my own countrymen, in danger from Gentiles; in danger in the city, in danger in the country, in danger at sea; and in danger from false brothers.[iii]

With these words, we are served notice of three truths regarding the harvest force: First that the harvest force is small; second, that the work, the act of harvesting, can be arduous and dangerous; and third, that the workers, in this case missionaries, are vulnerable to the dangers that do exist.

The author has been involved in a support ministry to evangelical missionary and Christian relief and development organizations since 1983.  Although the primary work of that ministry involves security and crisis management, there exists an inevitable and inescapable overlap between the external factor of security and the overall health of the Christian workers who make up the harvest force.  It is the author’s conviction, and the thesis of this paper, that external security factors, and more specifically, the organization’s competence and approach to handling security, are a major factor in the overall health of the missionary or Christian worker, and thus a major factor in the effectiveness of the ministry of the organization.

Consider three examples of the impact of security challenges, leadership response, and missionary reaction:  In the first situation, a violent insurgent group that exercised dominance over a significant portion of the country had kidnapped a missionary.  Ransom and other demands were pending, as were threats to kill the hostage.  Many of the remaining missionaries from the organization still lived at the location where the kidnapping occurred, a location that was within only a few kilometers of rebel-controlled territory.  During a meeting called to assess the ongoing danger to the rest of the missionaries, one made the statement “Except for the kidnapping, there has been less rebel activity around here than for the past several years” (emphasis added)[iv]. 

In the second example, field leaders of a missionary organization requested outside assistance in determining whether or not they should evacuate from their assigned location.  They were living and working in an area where two violent extremist groups were increasing their terrorist activities against the population at large, and also specifically against the Christian community.  In seeking assistance from an outside consultant, the field leadership described the security situation as follows:

• Terrorist activity was both increasing in frequency and expanding into the city where the missionaries were located – the most recent bombing in the city happened within two blocks of the mission’s offices.

• The day before the inquiry to the consultant was made, the military increased its threat assessment to the highest possible level, skipping several intermediate ratings.  At least a part of the reason for the military’s upgrading of the threat level was a major Christian holiday upcoming within a few days and the history of terrorist threats against Christians.

• One of the two extremist groups had just successfully kidnapped a number of foreigners and continued to hold them pending ransom demands.

• The field leader of the mission organization said that it was his evaluation that at that time, the missionaries were in “grave danger”.[v]

Based on the information received from the field leadership as cited above, and responding to the requirement of the mission that an evacuation decision be made immediately (before the consultant could travel to the scene to conduct an on-site assessment), an evacuation was recommended, almost immediately ordered, and rapidly completed.  Within a very few days, however, the evacuated missionaries, including the leader who reported the “grave danger”, were arguing to return and faulting the decision to evacuate.

In the third situation, a missionary organization received an extortion demand (of the “revolutionary tax” type) from an insurgent group.  The demand was consistent in form and content to those delivered to a number of organizations in the region.  Although the tone was firm, it was courteous.  Significantly, the organization had received a near-identical demand from the same group less than three years before, and following a personal meeting with leaders of the insurgent group at that time, the organization received an exemption from the demand and an endorsement of its work in the region.  Assessment and evaluation of this new demand by field and headquarters leadership of the organization, assisted by outside experts, concluded that there was a high probability of negotiating an acceptable resolution to the new demand.  It was also concluded that should the situation not be negotiable, there would be adequate time for an orderly evacuation and very little danger to any of the missionary personnel.  Plans were made accordingly.  However, part of the missionary group on-site rejected these conclusions, appealed to headquarters to restructure the crisis management team handling this situation, and some of the group unilaterally evacuated the area on their own.[vi]

In the first situation some of the missionaries felt that leadership was over-reacting to danger.  In the third situation some of the missionaries felt that leadership was under-reacting to danger.  In the second situation, some of the missionaries at first indicated a strong fear and appeared to be seeking “permission” to evacuate, but as soon as that happened, leadership was criticized for the decision and the group determined to return within a very few days.  Based on the author’s involvement in these cases, and with monitoring of these situations over time, there appear to be some common characteristics that mission organization leadership would do well to understand and consider as part of the overall program of care for their personnel:

1. Missionaries often tend to accept danger, and especially steadily increasing danger, as a normal part of the environment until a “critical mass” is reached.
2. Unless that critical mass has been pre-determined or pre-defined, the most common action is for individual missionaries to “tough it out” and accept levels of danger they are personally uncomfortable with in the absence of leadership guidelines to the contrary.  In such a situation, however, when the individual missionary finally determines that the danger level is unacceptable, the reaction is often hasty and ill-considered.
3. In the absence of contingency plans and pre-determined action points, when danger does impact a missionary team, one of the almost inevitable consequences is a crisis of confidence in leadership.  This often results in long-term organizational concerns that are more significant, in terms of ministry disruption, than the original danger.
4. In each of these profiled situations the author is convinced that the organizational consequences could have been significantly reduced, and the overall health of the affected missionaries significantly protected, with more effective and more proactive crisis management capabilities by the organization’s leadership.

    
THE LINKAGE BETWEEN SECURITY AND MEMBER CARE

It seems intuitively accurate to link security to the emotional well-being of people.  It seems self-evident to presume that people who feel physically safe will avoid some of the stress, tension and related problems of people who are constantly exposed to danger.  Those would seem to be normal reactions.  But are missionaries “normal”?  After all, missionaries are the only population who were known to travel overseas using caskets as luggage, anticipating their death in the line of duty.  Missionaries are certainly a population with a higher percentage of people motivated by faith in God than secular expatriate populations such businessmen, diplomats or military personnel.  But does this affect how they react and respond to danger?

John Fawcett serves as the Stress and Trauma Support Services Coordinator for World Vision International, and has considerable experience dealing with the impact of danger on Christian workers in the field.  He observes that 

(Christian) workers, along with all those with strong spiritual beliefs, may be significantly affected by exposure to such events (i.e., significantly traumatic events).  Rigidly held belief structures may not hold up under exposure to complexity and ambiguity.  The ‘ambiguity factor’ appears to be critical here.  The more black and white the belief structure held, the more strain it is under in contact with new and unusual conditions … For those who have a predominately positive world view – for instance, that God is a God of love and healing – the evidence of their own eyes can create internal conflicts of a profoundly traumatic nature.  The need to resolve these apparent contradictions and the amount of psychological and spiritual energy required to manage the confusion can lead to some workers needing to leave the field.  For a few, the choice has been suicide.[vii]

Fawcett goes on to say, “One aspect of stress and trauma that asks for more examination is religious or spiritual belief.  Traumatized staff display, along with the recognized psychological symptoms, profound spiritual trauma.”[viii]

Fawcett observes that Christian workers – missionaries - are not only susceptible to the impact of danger-induced stress, but even suggests that their faith can contribute to the stress and trauma they suffer when it is in stark juxtaposition with some of the graphic horrors of the world.  His observation is very much consistent with the author’s experiences in the field over the years.

In 1986, while conducting an assessment tour of a Latin American country besieged  by terrorist acts, the author was asked to present a workshop on sexual assault to a missionary audience one evening. At the conclusion of the workshop, as most everyone was leaving the room, a woman approached, asking for a private meeting.  During that meeting, which stretched through most of the night, the woman and her husband told of her being raped by a man in her home church, shortly before she left for the mission field.  Although the rape had been reported, the man had denied it and the woman had not felt supported (or even believed) by her church leadership.  Feeling rebuffed by the church, she had not sought any professional support or assistance to deal with the emotional trauma associated with the rape.  She brought the emotional aftermath of the rape, and the unsatisfactory experience of reporting it, with her to the mission field.  As this situation was discussed that evening, some very important things became apparent:

• By the woman’s own confession, the emotional aftermath of this violent incident was dominating her life
• It had made her, in her own words, completely ineffective as a missionary
• It had also significantly affected the quality of her relationship with her husband
• The husband reported that this had also affected his own effectiveness on the mission field

When this woman was asked to describe the emotions she was feeling, and how she was reacting to those feelings, the dominant response was that she felt guilty about how she felt.  Asked to explain, she described feelings such as shame, humiliation, anger, rage and a desire for revenge (against the rapist). She articulated her belief that feeling such things was un-Christian, and that she believed that experiencing those emotions and feelings was an indication that her faith, her relationship with God, was somehow flawed (otherwise, she would have more “Christian” feelings about what happened).  This case study graphically, albeit tragically, supports Fawcett’s observations.

Although the above case study deals with the aftermath of a single traumatic event, experience indicates living in a dangerous environment, or otherwise being exposed to danger on a more or less continuous basis, creates the same kind of stress and potential trauma.  In the three examples described earlier in this paper, at least a part of the emotional trauma that came into play during and after these events appeared clearly to be the result of longer-term exposure to a dangerous environment.  Others, such as Gill Eagle, have noted the same: 

Resilience literature is beginning to hint that prolonged continuous exposure to multiple, significantly traumatic events may not increase general resilience, as was previously thought, but rather lead to people becoming more vulnerable to the development of intransigent trauma symptoms.[ix]

     
WHAT IS THE ORGANIZATION’S REASONABLE RESPONSIBILITY?

If it is accepted, as both experience and the literature indicate, that security factors affect missionary health, and by extension, their effectiveness in conducting ministry, then the question becomes what should the organization do?  How responsible can the organization be for the safety and security of personnel?  And, what is reasonable for the organization to do?

It seems that first, we should be guided by Biblical principles.  Christ gave overwhelming evidence of being personally concerned with the lives and the well-being of his disciples.  Modern-day Christian organizations should do no less.  As Fawcett says “Any (organization) that presents itself as an entity valuing people will wish to demonstrate that same quality inside as well as outside (the organization).”[x]  Unfortunately, the issue of emotional trauma carries some stigmatization in the Christian community.  Some in the church, including some in missionary service and missionary leadership, have a genuine (but in the author’s judgment mistaken) belief that all psychology, and the disciplines that flow from psychology, is inconsistent with the basics of Christian faith.  It is beyond both the scope of this paper and the author’s competence to refute such a belief, but it may be helpful to consider contrary opinions from two different Christian perspectives.

John Testrake was the Captain of TWA flight 847, hijacked in the Middle East in 1985[xi].  A strong and committed Christian, John participated in the production of a videotaped account of his 17-day ordeal that is used to train missionaries for surviving in hostile captivity.  When asked about the broad issue of man’s actions, decisions and tactics perhaps being somehow contradictory to acceptance of God’s sovereign will and leading in human circumstances, John’s response was:

I feel that God gave me an intellect and a mind, and He gave other people with whom I work intellects and minds, and collectively we come up with better ways of doing things. I just have to give God the credit for maneuvering the situation around and improving on man’s efforts to make this thing work out successfully.

I like to look upon God as perhaps the manipulator of a giant lever. If I’m capable of exerting one pound with that big lever, then He magnifies that with that big lever and He turns it into a thousand pounds of effort.  BUT IF I DON’T APPLY THE ONE POUND, THE THOUSAND POUNDS IS NEVER EXERTED. (emphasis added)[xii]

Testrake describes a partnership in which God gives us certain tools and resources, and then expects us to use them to the best of our ability.  At the same time, God stands ready to step in with His sovereign will and power when it is the proper time for that to happen. 

Another Christian professional offers this view:

In health, as in all things, we should combine our faith in His ability to save and protect us with our own efforts to walk in the knowledge and understanding He has given us.  We can truly claim God’s protection only when we have done all within our power to follow the guidance He gives to prevent or alleviate our suffering.[xiii]

A missionary organization’s response to this issue can, and should, be divided into two components: First, there are proactive or preventative steps that can and should be taken.  Second, a prepared and adequate response system and protocol should be in place before a member suffers emotional trauma that requires access to that system and protocol.

Proactive Steps

“If adequate field support is not provided in the project infrastructure from the beginning, programs will fail and lives could be lost.”[xiv]  “Preventing traumatic injury is far cheaper than treating the impact of trauma … professional field staff are an increasingly rare commodity, and no (organization) can afford to lose essential staff through preventable causes.”[xv]  Dr. Richard Farley, a Christian and a clinical psychologist specializing in Post-Traumatic Stress Disorder, says, “In 1974 the U.S. Congress acknowledged the emotional needs of disaster victims.  Legislation was established that mandated funds be given to disaster-struck communities to establish community mental health programs.  The emotional needs of disaster survivors were to be cared for.  Can mission boards do less for their trauma victims?  Can we do less than the government does for its casualties?”[xvi]

The author’s experience in nearly twenty years of missionary work dealing with safety and security issues, and the findings of professionals such as Farley, Fawcett and others all point to the inescapable conclusion that an organization that is proactive in dealing with security issues will receive the additional benefit of having and keeping workers with better mental and emotional health.  A foundational security management plan for a missionary organization will include the following components:

1. Risk assessment – A structured and considered plan for evaluating the dangers that exist in particular countries, regions and venues; and a structured and considered system for informing members about those dangers.
2. Contingency planning – A well-considered set of policy guidelines covering the major components of security and crisis management[xvii]; and an organizational commitment to the development and maintenance (updating) of security contingency plans (for example, evacuation procedures).
3. Training – Based on the evaluation of risks and dangers faced within the organization, providing appropriate training to members.

One component of this preparation is the issue of emotional trauma.  Fawcett proposes a model that includes both pre-employment and in-field occupational stress-management components.  His pre-employment model includes

1. Providing applicants with accurate information regarding the program, country, political, cultural and current events

2. Providing general information regarding stress, stress management education, critical event and critical incident intervention

3. Providing new staff with specific, up-to-date country and security profiles.[xviii]

His in-field model includes parallels to the overall security management recommendations:

1. Each office having a comprehensive security management plan

2. Each office having clear policies regarding stress management

3. Each office providing access to appropriate stress management and trauma recovery resources (local and international)

4. Each employee receives a thorough briefing immediately upon arrival in the country with specific references to security issues

5. Senior or experienced staff are responsible for on-site orientations of new staff

6. With (organizational) assistance and on-going support, new employees are encouraged to develop and initiate (and maintain) his or her own stress-management program[xix]

It is also critically important that the organization communicate to its staff that it does value them, and that it is both aware of the potential impact of emotional trauma and is ready and able to assist the member in dealing with that trauma.  The organization’s commitment to this must be both visible and real.  “Such programs should not be confined to phrases in corporate mission statements but need to be clearly measurable components of a complete human resource management structure.”[xx]  The author is aware of a missionary organization that is training some members in the recovery process known as the Critical Incident Stress Debriefing (primarily a method of intervention following trauma), but which has recently closed out its psychological services department and professional staff.  One cannot help but wonder what kind of mixed message this may appear to be to members of that organization.

Indeed, the literature suggests that the individual member’s appreciation of the commitment and competence of the organization’s leadership is a large factor in the prevention and mitigation of emotional trauma.  Jonathan Shay says,  “The most effective way of preventing stress injury is the all-around excellence of leadership – leadership that strengthens staff in this way also creates trust, mutual respect and positive enjoyment of the field community.”[xxi]  In his book Failure to Scream, Robert Hicks says

Trauma brings to the surface all the dissatisfaction in our lives.  Since one of our major identity roles is found in our jobs and careers, if this area is producing a generous amount of satisfaction, then work can become a place of therapy for the traumatized.  If, on the other hand, it is a place of dissatisfaction, then the dissatisfaction turns to total disillusionment.  In response, the individual, often within the year of the tragedy, leaves the job or career.[xxii]

Just knowing that someone understands, cares and is willing to help in these traumatic situations is a key to emotional health and recovery.  Jerome Cook and Leonard Bickman studied 96 people who were victims of a major flood in Virginia at one-week, six-week and six-month intervals.  They concluded that the mere perception and knowledge that financial assistance and social agency support were available were critical in lowering initial traumatic symptoms.[xxiii]

A Response Protocol

It is inevitable that despite best efforts at staff screening, risk assessment, contingency planning and training, some events will occur that will result in traumatic emotional injury to missionary staff.  The first step in responding is the understanding by the organization of the need for policies in this area.  The author has a professional background in law enforcement, and there are clear parallels between missions and law enforcement regarding the “stigma” attached to emotional and mental trauma, and especially the seeking of professional assistance to deal with that trauma.  In law enforcement, experience in years past was that far too many police officers, after being involved in shootings or similar highly emotional events in the line of duty, became dysfunctional, left the profession, and even committed suicide.  The profession’s initial efforts to deal with this involved providing access for police officers to qualified mental health professionals following such events.  But that didn’t work, primarily because the organizational culture was a strong disincentive for the officer to take advantage of this resource.  The stigma was just too strong.   Only after law enforcement recognized this, and dealt with it by creating policy mandates requiring officers to meet with mental health professionals after such events, was a turnaround detected.  The author has seen many of the same reactions to seeking professional mental health assistance from missionaries as he did from police officers.

In its training for missionary organizations, Crisis Consulting International (the author’s organization) recommends that the organization have a policy mandating immediate intervention, and followup as indicated, following traumatic events.  Dr. Karen Carr, recognized as a leader in this field in the missionary community, offers similar but more in-depth recommendations:

If we can equip missionary administrators to recognize early symptoms so that they can make appropriate referrals and compassionate interventions, then we can go a long way in reducing the numbers of casualties on the mission field.

There are three very important goals that each mission board should have in response to traumatic events:

Goal #1 – Response and Prevention:  Any missionary who experiences any type of trauma should receive an immediate response which is designed to enhance his or her coping resources and to prevent the development of stress related illnesses.

Goal #2 – Early Recognition:  Each mission center should have the training and capability to recognize early signs of stress or mental illness so that early intervention can be provided.

Goal #3 – Referral for Treatment:  Each mission center should have representatives who have received training that provides them with the capability to refer missionaries who are experiencing multiple and prolonged symptoms of stress related disorders to a mental health professional.[xxiv]

The concept of peer support should also be a major component of the organization’s response plan.  Peer support has both proactive (preventative) and reactive (post-event) value.  Law enforcement and other public safety agencies that deal with highly traumatic events on a regular basis are increasingly embracing the concept of formal peer-counselor programs, training police officers, firefighters and paramedics in this area.  In his research regarding combat during the Vietnam War, Shay concluded that there is a direct relationship between a soldier’s ability to withstand the emotional trauma of combat and violence and the strength of his relationship with fellow soldiers (his peers).[xxv]  Especially when dealing with violence, danger, moral depravity or any of the other “blacker” areas of human behavior, there is a very unique quality that a co-worker, who has shared the same (or similar) experiences can bring to the individual struggling to cope with what he or she has seen or experienced.  The author’s wife (a 28-year veteran police officer) has been a peer counselor with her police department for many years and can attest to the fact that fellow officers will contact and confide in a trusted co-worker long before they would do the same with a superior officer, a mental health professional, and in many cases even a spouse.

It is important, however, that co-workers who might fill this role have a good understanding of both appropriate and inappropriate means of support, and also have a solid appreciation of boundaries and limitations in their own competence.  Dr. Farley provides valuable guidelines:

1. Model Christ’s love by being supportive and non-judgmental.  The survivor is usually his/her own harshest judge.

2. Maintain strict confidentiality.  Do not violate the survivor’s trust.

3. Be available to what may be a full and oftentimes contradictory range of emotional expression.  Even if the feelings are unfair or uncalled for, remember that to be supportive means to be receptive to the complete range of the survivor’s expressions.  Speak the truth in love and not as a dictator. Tolerate their feelings and behaviors within the confines of good judgment.

4. Sometimes just being there for fellowship, to cry or pray together, or simply for a time to be quiet together is what the survivor needs most.

5. Remind the survivor that it is normal to experience conflicting emotions simultaneously.  The horror of recounting specific events, joy over surviving, grief for those who may not have been so fortunate, and guilt over not having performed up to one’s expectations – all are normal emotions.

6. Be a liaison for the survivor to friends, family and the organization.

7.  Assist the survivor with planning for the immediate future.  Dealing with issues such as needed time off from work and other responsibilities or coordinating medical care are all important.  Be careful of the survivor’s premature desire to “get back in the saddle”.

8. If involved closely with the survivor or the event, take care of yourself, too.  Burnout can be a very real problem.  Be sure your own support system is intact.

9. Be ready to admit it if you find yourself “in over your head” with the survivor’s issues.  Requesting help from a qualified professional may be essential.[xxvi]

The Critical Incident Stress Debriefing (C.I.S.D.) is an intervention process developed by Dr. Jeffrey Mitchell and Dr. George Everly.  Although originally intended for use in the public safety sector, experience has shown that it can be used in almost any setting.  Dr. Carr specifically recommends C.I.S.D.:  “I believe one of the best models which is designed to prevent the development of PTSD is the Critical Incident Stress Debriefing developed by Jeffrey Mitchell … In my experience this model has a much broader applicability (than just emergency services personnel).[xxvii]

Greatly summarized, the C.I.S.D. is a “ group meeting or discussion about a distressing critical incident. Based upon core principles of education and crisis intervention, the CISD is designed to mitigate the impact of a critical incident and to assist the personnel in recovering as quickly as possible from the stress associated with the event.  The CISD is run by a specially trained team which includes a mental health professional and peer support personnel from (the organization).”[xxviii]

The general principles of the C.I.S.D. include

1. CISD is not psychotherapy.

2. CISD is not a substitute for psychotherapy.

3. CISD should only be applied by those who have been specifically trained in its uses.

4. CISD is a group process.

5. CISD is a group meeting or discussion designed to reduce stress and enhance recovery from stress.  It is based upon principles of crisis intervention and education, not psychotherapy per se.

6. A CISD is a team approach.  A CISD team is comprised of a mental health professional and several peer support personnel.

7.  A CISD will not solve all of the problems presented during the brief time frame available to work with distressed personnel, but it may mitigate those that persist.

8. Sometimes it will be necessary to refer individuals for follow up assessment and/or treatment after a debriefing.

9. It is not necessary for everyone in the group to speak during a debriefing process for the process to be beneficial.

10. Generally it is best to have a voluntary debriefing, but there are times when it is better for the good of the group to require the attendance of all involved personnel.

11. Following most well-defined and delineated acute traumatic events, the ideal time for a debriefing is after the first twenty-four hours and before seventy-two hours.

12. CISD is primarily a prevention program but it can be used to mitigate post-traumatic stress as well.

13. Although CISD is a technique which was developed specifically for emergency personnel, it has been applied, with great success, to many types of non-emergency workers.

14. CISD accelerates the rate of ‘normal recovery, in normal people, who are having normal reactions to abnormal events’.

15. CISD should be considered as only one helpful technique under the general heading of Critical Incident Stress Management (CISM), an integrated system of interventions which are designed to prevent and/or mitigate the adverse psychological reactions that so often accompany emergency services, public safety and disaster response functions.  CISM interventions are especially directed towards the mitigation of post-traumatic stress reactions.

16. A CISD is best provided by those who are not well-known to those who need it.

17. CISD is a crisis intervention process designed to stabilize cognitive and affective processes and to further mitigate the impact of a traumatic event.  It is NOT an operational critique of a crisis situation or traumatic event.[xxix]

    
CONCLUSION 

Researchers, private sector employers and even government agencies recognize the potentially destructive effect post-traumatic-event emotional trauma can have on staff members.  There is also increasing recognition that in addition to the damage this trauma causes to individual employees, there is a corresponding negative impact on the organization.  These factors apply in the Christian environment, including the missionary environment, just as they do elsewhere.  However, there can be an added destructive dimension for Christian victims who mistake normal human reactions to horrific events with unspiritual, or even sinful behavior.  Coupled with a certain stigma against psychology and professional mental health intervention that exists among the Christian community, the result is the real potential for higher-than-necessary casualties of emotional trauma amongst the harvest force of missionaries. 

Perhaps the most challenging step for a missionary agency that seeks to address this entire area will be dealing with that stigma.  Facing the issue head-on, recognizing the partnership between human endeavor and God’s sovereignty that Captain Testrake described, and appreciating that the Biblical concepts of stewardship must certainly apply at least as much to people as they do to replaceable assets such as money, will help dispel the stigma.

Any organization that seeks to address the broader issue of fully caring for its members in a challenging security environment will develop a comprehensive program:

1. First, the organization will maintain a competent overall security and crisis management program that includes risk assessment, policy setting and contingency planning, and training.
2. Second, the organization will incorporate the principles outlined herein throughout its personnel management and human resource management systems.
3. Third, the organization will develop policies that both delineate and mandate appropriate intervention for its members following traumatic events, and will demonstrate both the importance of these programs and the value it places on the emotional health of its members in all appropriate ways.
4. Finally, the organization will implement programs such as peer support and a C.I.S.D., so it provides early intervention and support in cases of both singular traumatic events, and cases of lower-level but constant (or increasing) danger and stress.

Presented at the Evangelical Missiological Society National Conference 2000, Nashville, TN, Nov. 15, 2000.

Crisis Consulting International
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