state of the art on psychosocial interventions after disasters

This project has received research funding from the European Union

State of the Art on Psychosocial Interventions after Disasters

Barbara JuenIPRED Tel Aviv

January 13, 2014

• Project aiming at – Operationalizing psychosocial support in crisis• Static part of platform (glossary, toolbox, guidelines and

handbooks, comprehensive guideline)• Flexible part of platform (OGS to be used by affected,

crisis managers and helpers before, during and after crisis)

OPSIC

In total we analysed 324 guidelines and handbooks regarding

1. Content/Phases, Event types, target groups/ key recommendations/ethical aspects/gender aspects/cultural aspects

2. Quality/Procedure of development, scientific criteria

Analysis of guidelines and handbooks

• Process of decision making (where all actors involved in decision making? Where they given sufficient information? see Svedin, 2011, p.13)

• Behaviours of decision makers

whether or not leaders acted according to certain values (e.g. Human rights), which parts of their decision they make visible and which not and for what reasons

• Judgement of whether decision makers should have acted or become involved at all (Svedin 2011)

Ethical aspects in disasters

• Ethical aspects in disasters mentioned in the guidelines involve the aspects of Due Process, Dignity and Human Rights, Non-Discrimination, Privacy, Confidentiality and Data protection, Transparency and Accountability (focussed mostly on behaviour of decision makers and helpers but less on process of decision making and judgement or whether involvement was right)

– Dilemmas arise especially around human rights, unequal distribution of disaster risk and vulnerabilities, the question of who has the right and who has the duty to intervene, the question of who is informed and how much and who gives information, the possible negative effects of the media as well as the unequal distribution of support especially the question of not supporting vulnerable groups because of various reasons.

– Ethical communication means that governments establish a fair and open dialogue with all stakeholders that aims at consensus (Olsson, 2011).

Ethical aspects

• Cultural aspects in disaster guidelines are often reduced to cultural differences in mourning and social behaviour. It is stated that helpers should come from the local culture and local culture has to be involved in decision making

– But: Looking closer at cultural aspects in disasters we soon realize that culture is a dynamic, nonhomogenous concept and is closely interlinked with other aspects that define power relations in society like ethnicity, gender and class

– The general trend in the future therefore is to look not only at differences between and within groups but also at inequalities between and within groups and communities

Cultural aspects

• Gender is often treated in the guidelines as a mere issue of vulnerability and protection

– But: The gender perspective in disasters has shown, that an intersectional approach is called for. Gender like culture may not be treated as a standalone category

– Looking at gender in disasters the following aspects should be taken into account: capacities and strengths of women, household structure, gender politics, inequalities and intersectionality, men and women, women´s groups

Gender aspects

• Guidelines have many similarities• They may focus on different aspects but in

general there is a broad consensus

Key recommendations

• Resilience approach (individuals and groups can be supported to make use of resources and come back to normality)

• Most trauma reactions are normal and transient and have a broad variety (normalize reactions, inform about reactions and coping but be aware of medicalisation and too much confrontation)

• Importance of secondary stressors (e.g. resource loss, lack of social support)

• There is a need for both psychosocial and mental health care (stepped approach, multi layer approach)

• The majority of the affected do not need specialized mental health care but still need psychosocial support (psychosocial before clinical approach)

• 5 effective principles of intervention by Hobfoll (2007) (safety, connectedness, calm, self and collective efficacy, hope)

• Screen for risk factors (symptom screening lateron and not for everybody)

Key findings from the evidence

• Use Needs orientation • Use Anticipation, Planning, Preparation and Advice• Focus on Families and Communities• Develop, Sustain and Restore Psychosocial Resilience• Ensure human rights and equity• Ensure participation• Do no harm• Build on available resources and capacities• Use integrated support systems (no stand alone services)• Use multi-layered supports

Core Principles

• Psychosocial support according to the Hobfoll prinicples (umbrella approach for all phases using different intervention formats)

• Psychoeducation (information about reactions and coping) use dialogue, be aware of medicalization and too much confrontation

• Psychological first aid (intervention in the very acute phase) according to the WHO principles (Observe for safety, listen to needs, connect to futher support and social networks)

Key interventions

• Broad consensus in suggested intervention formats and the importance of prevention

• Broad consensus in key interventions resp psychological first aid, psychoeducation, psychosocial support

• Gaps regarding ethics, gender and culture• Gaps regarding longterm support and

longterm effects

Resumee

• Thank you for your attention