Transcript Dia 1 - European Society for Traumatic Stress Studies

The European Network for Traumatic Stress
Training & Practice
www.tentsproject.eu
Community Interventions
Dean Ajdukovic
Learning outcomes
•
Upon completion of this module, the
participants should be able to:
1. Describe the impact of traumatic
events on communities
2. Describe specific approaches to
effective interventions for communities
Contents
• What are community-based interventions
• Impact of traumatic events on
communities
• Stages of community recovery affected by
disaster
• Vulnerable groups requiring special
attention
• Specific approaches to effective
interventions for communities
What are community-based
interventions?
• Activities that facilitate normalization of
social, family and individual psychosocial
functioning in a community affected by a
disaster in order to:
• Promote a sense of safety, self and
community efficacy/empowerment,
connectedness among community members,
and increase hope in recovery of individuals
and the community
• Provide support and treatment to people with
difficulties in family, work or social functioning
Impact of traumatic events on
communities after a disaster
• Destroyed homes and fragmented
communities make survivors highly
vulnerable  the priority is safety
• Finding missing family members is the
primary concern of survivors
• Overwhelming demand for support while
natural support systems are shattered 
need for immediate and organized
psychosocial support and care
Impact of traumatic events on
communities after a disaster
• Loss of work and opportunity to support own
family increases helplessness
• People are concerned that the communities
will not recover which increases
hopelessness
• People may experience loss of control over
own life
• Likely increase of family violence, child
abuse, substance abuse
Stages of community recovery
from disaster
Initial stage (within first week) - people
display:
• Overwhelming feelings of fear, terror and
anxiety
• Thought confusion
• Behavioral disorganization and difficulties
in decision making
• Concern with wellbeing of about important
others
Stages of community recovery
from disaster
Second stage (within the first month):
• Strong bonding emotions and empathy
among survivors, non-victims and helpers
• Massive aid from authorities and other
communities, attention from the media
help people feel of being supported and
connected
Stages of community recovery
from disaster
Third stage (several months after a disaster):
• The interest and support of the wider
society decreases, leaving the survivors in
the affected community feel left alone to
struggle with the recovery and rebuilding
issues
• People often complain about various needs
that are not fulfilled as promised, including
the care for the trauma sufferers
The society expects the disaster
survivors and their communities:
• To start functioning normally as soon as
possible
• Look forward to the hard work of
rebuilding their homes and lives as a
challenge
• Leave their suffering behind, together
with their traumatic experiences and
symptoms
Target groups for community
interventions
• Circles of vulnerability include people who
have been exposed to traumatic
experiences and a disaster at different
intensity:
– Those directly involved and their families
– Witnesses, friends and “near misses”
– Emergency personnel and helpers
• These groups should have access to a
range of psychosocial care interventions
Circles of Vulnerability
Vulnerable groups requiring
special attention
• Children and adolescents since their
development can be affected by exposure
to trauma and extreme distress
• Elderly who depend more on other people
for a variety of services
• Pregnant women, single parent families
who are more dependant on
organizational support from the family
Vulnerable groups requiring
special attention
• People with chronic illness who may need
special medical attention or assistance to
access services
• Children and youth without parental support
and supervision
• People with health-related dietary needs
• People who do not understand language,
procedures, legal requirements (e.g
immigrants, minority group members)
Children and adolescents have
increased need for care
• Communities and families focus on rebuilding
infrastructure, homes and jobs which absorbs
most of their time and energy, neglecting the
increased needs for support and care among
children and adolescents
• Highly distressed adults sometimes do no
recognize increased emotional needs of
children and adolescents, and provide too
little support before psychological and/or
behavioral difficulties externalize
Social support after disasters
• Social support includes providing
information, help with practical issues and
meeting the socio-emotional needs
• As the basic needs are met (food, water,
shelter and safety), the psychological
defenses diminish, and the awe of the reality
may become overwhelming that individuals
become numb and feel powerless, unable to
make decisions and maintain active coping
Community interventions
Community-based interventions should
enhance the coping capacity:
• Individuals: To deal with disturbing
posttraumatic reactions and integrate
traumatic experiences and losses
• Communities: To find culturally
appropriate ways to deal with losses and
ensure a safe environment which is
conductive to healing
Specific approaches to
community interventions:
• Practical help given in an empathic manner
• Emotional support and initial reassuring of
distressed individuals
• Providing information (e.g. tracing family
members, accessing temporary housing,
food, social benefits, access to health,
psychological, legal services)
• Material assistance (e.g. providing housing,
food, financial benefits, rebuilding
infrastructure)
Specific approaches to
community interventions:
• Employment (e.g. retraining to increase
employability and independence)
• Facilitating mutual support and special
interest groups
• Providing psychosocial care interventions to
the affected population
• Organizing memorial events and building
monuments with active participation of the
disaster survivors
Community interventions:
Providing information
• Setting up the information center for
survivors and care providers, with web-site
and telephone response service
• Publication of information for victims,
family members, aid personnel
• Contact details of authorities and services
that are responsible for different aspects of
disaster response
Community interventions:
Providing information
• Education about psychosocial
consequences of disasters
• Information about variety of available
mental health services and referral
procedures
• Collecting and analyzing victims’ questions
and securing responses
Community interventions:
Material assistance and benefits
• Identification of people and families that
are in need and entitled to material
assistance and benefits
• Dissemination of information to these
people
• Organizing orderly and transparent
distribution of assistance
• Providing legal advice about insurance
and compensation
Community interventions:
Housing and rebuilding
• Housing and infrastructure rebuilding is a
key element in bringing the populations
back to their original communities after a
disaster
• Providing building materials, loans and
know-how facilitates community rebuilding
• Rebuilding institutions (schools, health
clinics, communal services) are essential
for the normalization of life patterns
Community interventions:
Employment provisions
• Training and retraining people to increase
their qualifications and competitiveness at
the job market
• Tax plans that stimulate investments in the
affected community
• Communal services that hire primarily the
people with poor employability
• Providing loans to start small businesses
or buy agricultural equipment
Community interventions:
Psychosocial services
• Psychoeducation about ‘normal reactions to
abnormal situations’ for specific groups
(e.g. adolescents, children, elderly, parents,
teachers, community workers)
• Support groups with special interests,
backgrounds or experiences (e.g. survivors
of family losses, families with missing family
members)
• Informal, recreational and creative activities
using the local tradition and culture
Community interventions:
Psychosocial services
• Identification and referral of individuals with
disturbing posttraumatic psychological
functioning
• Psychological counseling, grief work
• Support and consultation by mental health
providers to the staff in community
institutions (schools, community clinics,
churches, youth clubs) to help re-establish
normal routines and work with highly
distressed users
Community interventions:
Psychosocial services
• Advising community authorities on the
mental health issues
• Networking with providers in communities
with similar experiences
• Develop and put in place evaluation
procedures that will demonstrate the
effectiveness and accountability of
services
* Psychiatric medication
* Treatment of dysfunctional
traumatized clients
Level of
* Individual, family, group counseling
service
* Loss, grief and worry work
expertise
* Psychological evaluation and referral
* Social and life skills building groups
* Self help and mutual support groups
* Emotional support provisions by trained para-professionals
* Guidance in structuring free time
* Networking (e.g. youth, elderly, special needs groups)
* Family reunification
* Training of care-providers and dissemination of skills and knowledge
* Public awareness of “normal psychological reactions to abnormal situations”
* Information on accessing other services, about legal status, missing ones
* Facilitating basic social structures, institutions, roles and responsibilities
Number of clients served / allocation of resources
Pyramid of community psychosocial intervention
(Ajduković, 1997; Ajduković & Ajduković, 2003)
Community interventions:
Developing local psychosocial
service capacities
• Training local care-providers to
increasingly take over responsibilities for
psychosocial services
• This is the key to ensuring sustainable
community services that will be needed
years after a disaster  outside
assistance is always time limited
Staff-related issues
• Because of high workload, difficult working
conditions and a large number of distressed
individuals, the psychosocial staff is exposed
to high levels of professional stress and
vicarious traumatization
• Procedures should be provided that help
prevent burnout, regular supervision,
consultation with peers and outside
consultants, opportunity for professional
growth and facilitating supportive team spirit
Consider the time
• Community interventions in the aftermath of
a disaster need time to yield results
• The affected population is highly distressed
and typically impatient to see improvement
in own mental health and well-being as well
as the community rebuilding
• Those involved in providing community
interventions have to deal with two
conflicting qualities: work hurriedly and be
patient