A stepped-care approach to bushfire recovery

Enter Phoenix Australia’s award-winning Bushfire Recovery Project, funded by the Federal and Victorian Departments of Health. In 2020, we were engaged to increase the capability of workforces in disaster-impacted communities through the delivery of best practice trauma-related mental health training and mentoring activities. The project was initially intended to support recovery from the Black Summer bushfires; however, ultimately, our programs were accessed by more than 4000 frontline workers from communities all over the country that have been impacted by recent disaster events. 

Initial consultations with bushfire-impacted community members indicated that in order to effectively build resilience and foster disaster recovery, our training offerings should align with the ‘matched’ or ‘stepped’ care approach to psychosocial support. This project was one of the first in Australia that was able to increase local capability aligned with this best practice approach. 

“We had the Black Summer bushfires which obviously was quite an extreme event… The end of the bushfires in February literally led straight into the COVID pandemic. The normal responses to a disaster – gathering and supporting each other – couldn’t happen because of COVID. After COVID, we’ve had seven storms or floods which included a hailstorm. So, all up in the last two and a bit years, we’ve had ten declared natural disasters. They’re the disasters that the community has been coping with in the last two years.”

– Disaster-impacted community member

What is stepped or matched care? 

Designed to offer people the specific type of support matched to their particular needs at a given time, the evidence-informed,  internationally employed stepped or matched care approach delivers mental health interventions hierarchically. This hierarchy of interventions is often represented as a pyramid, with the least intensive intervention and most widely needed intervention at the bottom of the pyramid and the higher layers representing increasingly intensive interventions but required by fewer people who develop more significant mental health issues. 

 The Bushfire Recovery Project involved matched-care approach comprising three levels of care:

• Level 1 – Trauma-informed Care (TIC) and Psychological First Aid (PFA) for community leaders, emergency service workers and recovery workers. These interventions are designed to provide information and support to instil a sense of safety, control and hope for recovery. Trauma-informed Care, while a level 1 intervention here, is relevant and applicable to all levels of  interventions. 
• Level 2 – Skills fOr Life Adjustment and Resilience (SOLAR) for health and recovery workers. Level 2 centres around providing simple psychological strategies designed to target common, often transient psychosocial difficulties.
• Level 3 – Trauma-focused Cognitive-Behavioural Therapy (Tf-CBT) for mental health specialists. Level 3 centres around evidence-based interventions targeting mental health disorders, including trauma-focused therapies designed to treat posttraumatic stress disorder (PTSD). 

The matched-care approach of the Bushfire Recovery Project was one of its unique and key strengths: it allowed the project team to take a truly comprehensive and strategic approach to bolster community resilience, equipping a diverse range of community members – from psychologists, general practitioners and recovery workers to community leaders, emergency service personnel and other frontline workers – with the relevant evidence-informed skills to support their community. For example, the majority of the over 4000 individuals who participated in Bushfire recovery Project training were trained at Level 1, as these are the interventions most widely needed by disaster-impacted communities. Fewer people were trained in the more specialist interventions at Level 2 and 3. 

Taking a matched-care approach also helped with local workforce issues. For example, equipping frontline workers, non-mental health professionals and community leaders to deliver the Level 1 lower-intensity psychological support meant that the limited mental health specialists could focus on providing Level 3 treatments to those who go on to develop mental health disorders.

Aligning with the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings, the team also bolstered the three levels of care with a targeted mental health literacy campaign for the broader community – through local media, social media and email communications. This centred around strengthening community and family support, including non-disaster-related initiatives that encourage social connection and supporting families. The team also strived to promote recommendations for others working in the disaster mental health space to adopt a  trauma-informed approach to their work. 

Putting community members at the front and centre

Our project’s success supports the notion that frontline workers such as community service providers, emergency services volunteers, and staff are well-placed and willing to deliver low-intensity interventions as respected and connected members of local communities. 

Embedding these skills in communities ensures those impacted by previous disasters have access to low-intensity interventions and prepares communities with a surge capacity of trained PFA, TIC and SOLAR providers in preparation for the next disaster season.

Feedback from those who accessed our training programs has been overwhelmingly positive. Over half of the participants used their skills gained from the training within three months of completion, and 99% reported that they felt the person they were supporting benefited from the application of the skills from a moderate to a great extent. And 100% of training participants said that they would use the skills again in other similar situations supporting impacted individuals. 

Understanding the specific needs of different communities was critical to our strong uptake of the training and our engagement with local community leaders and organisations. The onset of the COVID-19 pandemic and multiple flooding disasters saw the project team pivot to online and blended delivery modes for the training workshops. The project team also expanded eligibility to include a broader range of workshop locations and community members, so we could be responsive to those reaching out for support. Finally, the project became as much about helping communities to prepare for future disasters as it was about supporting recovery from Black Summer bushfires. 

“I did the online training because I couldn’t have travelled for face-to-face training during Covid. I liked the video experts. There were scenarios I could identify with, and I like that you have to engage with interactive elements of the training. There were some good graphics that explained things very simply. Now, as a unit, we are talking about changes we could make next year. We’ve agreed with training officers to build in a mental health component into each job.”

 – Lindsay, TIC participant. 

Our partnerships and engagement with local community leaders and organisations were also critical to our strong uptake of the training. The local bushfire Coordinators selected the training locations, and in the case of Mallacoota in Victoria, community leaders extended us an invitation to deliver training. Other communities that received initial training rounds, such as Corryong, went on to reach out to Phoenix Australia to request further workshops as they recognised a  continuing need, particularly given that the COVID-19 pandemic delayed recovery from the bushfires. 

The matched-care approach was essential to the success of the Bushfire Recovery Project, empowering and being responsive to those impacted by disaster. 

The Phoenix Australia team looks forward to adopting a matched-care approach for a number of our other initiatives to support the mental health of disaster-impacted individuals and communities in the future.