Dr. Joseph O. Prewitt DiazMs. Sujata BordoloiDr. Sibananda MishraMs. Anjana RajeshDr. Satyabrata DashSmt. Indrani Mishra

Community Based Psychosocial Support Training for

Community Facilitators

AcknowledgementsThis manual has been produced with technical and financial con-tribution of the American Red Cross. The authors are responsible for the views expressed herein. This Manual is an adaptation of

Salud Mental en el afronte de Desastres manual developed by the Peruvian Red Cross with the financial support of the Ofi-

cina de Asistencia para Desastres en America Latina y el. The original manuals used widely in the Americas have saved many lives. We hope that this Manual will provide timely information

to community facilitators, field workers, and trainers so that disasters may be dealt with in the community in an effective

and timely manner.

Community Based Psychosocial Support Training forCommunity Facilitators

The following people are acknowledged for the development of this manual:

Technical Lead: Dr. Joseph. O. Prewitt. Diaz Indian Adaptation Ms. Sujata Bordoloi Dr. Sibananda Mishra Mrs. Anjana Rajesh Dr. Satyabrata Dash Smt. Indrani MishraPrinting coordination: Ms. Mridu Rattan Field testing for cultural applicability: Mr.S.C.Dakua, (Orissa DMH/PC Programme) Mr.Ranjan Mohanty Mrs.Sunita Pradhan, Mr.Snehal Shah (Gujarat DMH/PC Programme) Ms.Poonam Vyas, Ms.Khyati Vajeria

VHAI Contribution:Editing and Proofreading Puja SharmaCover and Illustrations Brajagopal PaulTypesetting and Layout Subhash BhaskarPrinted at VHAI Press

This manual is dedicated to the millions of people of India who have experienced crises and have overcome their grief and losses. They have moved from victims to victors.

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The frequency of disasters such as road accidents, epidemics, droughts and floods has increased multifold. Many more people are suffering from injuries, disabilities, mental and physical diseases. This is a matter of great concern to the communities, whose social, economic, and health status get seriously disturbed.

India is particularly prone to disasters. Its vastness, its ecological system, its geographical position makes it vulnerable to natural and human made disasters. Year after year people are subjected to intense suffering and immense losses. The poor bear the brunt of it. No one is spared.

Seeing the intensity of devastation and impact on the mental and physical well being of the survivors, the American Red Cross Society has developed a program to prepare communities to emotionally respond to and deal with the disasters.

To ensure the recovery of physical, emotional and psychological health, special emphasis has been laid upon disaster mental health and psychosocial care.

The focus of the training modules is on the disaster survivors and vulnerable groups who are geographically situated in disaster prone areas, or who are likely to be more affected because of the age group they belong to e.g. the elderly or the very young. The training will further help already existing community, leaders and volunteers to deal with these situations better. It is also for the benefit of any member of the community who might have to take on sudden responsibilities when faced with disaster.

Introduction and

Purpose of

Training

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The methodology used in the modules is participative and interactive, with more emphasis on brainstorming, group work, role plays and the workshop method rather than lectures and presentations. Energizers are activities to recharge the group when they might be tired or losing concentration. Procedures are given as guidelines for conducting each of the activities.

Evaluation of the participants’ performance is based upon the pre test at the beginning and post test at the end of each module. The evaluation will measure:

a) the extent to which the participant has imbibed the information and knowledge on the topic

b) the effectiveness of each module and how far the objectives have been achieved.

Group dynamics and motivation are integral to the modules. This encourages discussion and leads to interaction between participants on the one hand, and the facilitator and the community on the other.

Total duration of training programme = 56 hours

Modules I,II & III should be covered in Phase I

Models IV,V & VI could be spaced out over 2 months. This would ensure better absorption of the knowledge and a good understanding of the procedures to be followed. Allocation of time is flexible – as per the requirements of the group and the instructor.

Introduction to Training Programme

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Training Programme

for Community

Facilitators

Goal Enhance the capacity of community leaders, volunteers and members to carry out community based disaster mental health and psychosocial support activities.

Objectives : • Introduction to the Red Cross Movement and the Sphere Standards of mental and

social health underlining the minimum quality of service to be rendered.

• Facilitate the leadership and communication skills for the community facilitator.

• Describe the activities that define Psychosocial Support.

• Develop methods to promote community based Psychosocial Support before, during and after a disaster.

• Facilitate the capacity of communities to carry out resilience activities.

• Teach basic skills to deliver psychological first aid.

• Elaborate the basic methods of teaching.

Outputs: At the end of the training, the participants will be able to:

• Identify and illustrate five qualities that describe a situational leader and a community facilitator.

• Explain at least five characteristics that are common to every disaster and five common responses to disaster.

• Illustrate at least two activities, each, that describes Psychosocial Support.

• Conduct a community needs assessment (find out the protective and risk factors and prepare a vulnerability map of the community).

• Develop at least three tools (trifold, drama and song) and prepare materials for promotion of disaster mental health in the community.

• Identify and carry out at least three Psychosocial Support activities in the community.

• Enumerate at least five principles of psychological first aid.

• Deliver the five steps of psychological first aid.

• Define and use at least three techniques of training.

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TABLE OF CONTENTS: MODULE I: ROLE OF A COMMUNITY FACILITATOR………………………...1. Communities and groups……………………………………………………2. Who is a leader ?……………………………………………………………3. The community facilitator……………………………………………………4. Conflict and conflict resolution………………………………………………5. Communication……………………………………………………………….Annex 1.1………………………………………………………………………Annex 1.2………………………………………………………………………Annex 1.3………………………………………………………………………Annex 1.4………………………………………………………………………

MODULE II: PSYCHOSOCIAL SUPPORT IN DISASTERS .………………….1. What is a disaster ?…………………………………………………2. Disaster Mental Health and Psychosocial Support…………………3. Common reactions to disasters………………………………………4. Mental Health in the community……………………………………5. Prevention in Mental Health…………………………………………Annex 2.1. ……………………………………………………………………Annex 2.2……………………………………………………………………

MODULE III:PROMOTION of PSYCHOSOCIAL SUPPORT……………………1. Promotion of mental health in disasters……………………………2. Strategies of promotion………………………………………………3. Guidelines for promotion………………………………………………4. Types of communication material………………………………………Annex 3.1………………………………………………………………………Annex 3.2………………………………………………………………………Annex 3.3………………………………………………………………………

MODULE IV: COMMUNITY BASED PREVENTIVE ……………………………DISASTER MENTAL HEALTH/PCYSHOSOCIAL SUPPORT ACTIVITIES 1. Tools for community organization……………………………………2. Psychosocial support and care activities………………………………3. Stress management and self-care techniques…………………………Annex 4.1………………………………………………………………………Annex 4.2………………………………………………………………………

MODULE V: PSYCHOLOGICAL FIRST AID……………………………………..1. Introduction to PFA……………………………………………………

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2. The concept of distress and stress…………………………………… 3. Importance on Non-verbal Communication……………………………4. Implementation of PFA…………………………………………………5. The Organization of Emotional Brigade……………………………….Annex 5.1………………………………………………………………………Annex 5.2……………………………………………………………………

MODULE VI: TEACHING METHODS…………………………………………….

1. Information………………………………………………………………2. Training and Information………………………………………………..3. Management of a classroom…………………………………………...4. Elaboration of lesson plan……………………………………………..5. How to elaborate visual aids……………………………………………6. How to use our own visual aids………………………………………..7. Methods of a training……………………………………………………8. Furniture and equipment………………………………………………..9. Method of evaluation……………………………………………………Annex 6.1…………………………………………………………………………Annex 6.2………………………………………………………………………

REFERENCES………………………………………………………………………

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Objective: To show how leadership and effective communication are the most important tools for the community facilitator.

Expected Outcome: The participants will be able to:• Work in and manage groups.• Identify and illustrate at least five qualities that describe a community facilitator

and a situational leader.• Illustrate and execute at least two activities that a community facilitator can

carry out in the community. • Acquire basic skills in communication.

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The Role of A Community Facilitator

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Give a general background of the Red Cross, its origin, its principles and its various activities. Talk of the Sphere Standard of mental and social aspects of health underlining that a minimum standard in the quality of service is to be maintained. And emphasizing that accountability is a must.

Then move on to • define groups, community and community participation.• describe the role of the community facilitator with two activities that he/she can

perform in the community. • define situational leadership and give two characteristics.• demonstrate the most effective methods of communication while working with

groups and individuals.

Pre Test (Annex 1.1)

Activity 1

This deals with establishing contact with people and retaining that contact information.

Ask a participant to give his/her name. Tell the next person to repeat that name and add on his/hers. This chain of names, each one adding on theirs to the list, must carry on till the last participant. How much a person can recall, will be an indication as to what extent we listen, retain and remember our social contacts.

l. Communities and Groups:l.l What is Group ?A Group consists of three or more people who get together and work together for a period of time, for a common reason. People get together because of similar interests, customs and regional backgrounds.

People in a group • share interests and goals.

• have certain rules and regulations that they abide by.

• participate in activities to strengthen the bonds.

Introduction

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• work towards common goals which in turn support the individual Groups. Are ever changing and have dynamic interactions. For example, the personal relationships between each member affect the overall interaction in the group, as well as its functions. These relationships change over time.

Groups can be of different kinds and can be based on: • Gender – Men and women • Age - Elderly, adolescents, children• Religious – Muslims, Hindus, Christians• Social - Family, friends, neighbours, co-workers

Activity 2: On formation of Groups. Distribute one card to each participant. Divide the participants having similar cards, in pairs. Five minutes will be given to the pairs to get to know each other. Then, one of the pair will introduce the other. Similarities and common interests will be discussed. This will be the basis for forming the groups.

Brainstorm on Groups

(Refer to handbook module-1 Q. No.1 Jamila , Venu)

1.2 What is a Community? A community consists of a number of groups of people, living in a particular locality, sharing common interests, traditions, language and lifestyle, interacting with each other and participating as a homogenous unit.

Activity 3:

Brainstorm on community

What do you understand by a community?

What are the main characteristics of a community?

What does your community look like?

1.3 What is Community Participation?Community participation is the way in which each member in a group or community takes part in decision making related to his/her community. The groups work together in achieving common goals for the development of the community and individuals.

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E.g., Members from different groups can form a local village committee to assess the psychological or social needs in the village and plan activities that can meet those needs.

Activity 4: On the importance of community participation:

The participants will stand in a circle with sufficient space between each other. Their task is to pass a glass around. After the glass has been passed on to the last person, the facilitator will instruct one participant to go out from the circle. The remaining participants are to continue the exercise without shifting position. It will now be difficult to carry on because of the absence of one member’s participation.

GROUP DISCUSSION on Community participation

(Refer to handbook module 1 Q. No. 3 Football Match)

2. Who is a Leader ? A leader is a person, who has the ability to show the way, has the interest and capacity to help others and is accepted voluntarily by the people.

Each community chooses their leader according to their own yardsticks and in the best interest of the community at large.

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Activity 5:

On the definition of a leader :

One of the participants will be blindfolded with a handkerchief. Some objects like books, chairs and bags will be kept on the ground of the training hall as obstacles. Then, another participant will be asked to give directions to help the blindfolded person walk through the hall without touching anything on the ground.

Brainstorm on qualities of a leader

Guidelines to discussion: Who is a leader? Identify some persons in your community who you think are leaders. What qualities in them make leaders?

2.l QUALITIES OF A LEADER :Certain characteristics in an individual make him/her more acceptable as a leader .These characteristics make members of a group/s more willing to be guided by him/her in decision-making processes.

• For example, what made the nation accept Mahatma Gandhi as their leader during the freedom struggle? It was perhaps the way in which he was able to represent the needs of the nation and take decisions after considering everyone’s views and opinions.

A good leader will be capable of:• Being a role model.

• Adjusting in different situations.

• Making people share their experiences and contribute.

• Capable of dealing with the expectations of others.

Here are some of the roles a leader must play:• Listener

• Motivator

• Initiator– taking initiative in beginning new processes

• Decision-maker

• Mediator

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• Observer – encourage people according to their skills and capabilities

• Advisor

• Communicator

• Friend• Advocate

(Refer to handbook module 1 Q.No.4 Anand)

2.2 WHAT IS SITUATIONAL LEADERSHIP?Situational leadership is:

• The ability to take charge in an emergency, crisis or difficult situation.

• By adopting a style that builds on the positive strength and abilities of people affected

• By observing and determining the needs of the situation at hand.

Situational leadership requires:

a) The skill to handle the situation

b) The will to take up the work at hand and be accountable .

Situational leaders are individuals who have the maturity to assign tasks and undertake responsibility in certain situations, which demand immediate action or response.

E.g. In a disaster situation some members in the community take the responsibility to carry out assessments - of the numbers injured or dead, nature and magnitude of losses suffered. They also ensure that relief material, medical facilities reach the people. These people become situational leaders because the community readily accepts them. They have also shown the ability to respond to a situation, responsibly and with care.

Elements of situational leadership:

The person should have the ability to

• Take responsibility.

• Communicate with different groups.

• Respond according to needs and skills of the group and group members.

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Activity 6:

Rope Game on tackling a problem situation. A pair of participant will have their hands tied by a rope in a difficult knot. They have to somehow open the knots. Other participants can suggest different ways to do so. The ‘knotted pair’ must decide and act on the instructions. It is to be seen that whose advice will enable them to successfully untie themselves?

Conclude on Situational leadership.

Lecture & Brainstorm on Situational leadership

(Refer to handbook module 1 Q. No. 5 On flood/fire)

3. THE COMMUNITY FACILITATOR3.l WHO IS A COMMUNITY FACILITATOR ?This is a person who, keeping the interests of a community or village in mind and is capable of initiating action for the welfare and protection of all. Special emphasis is given to psychosocial support by way of promotional and preventive activities on mental health. This equips the community to deal with disaster situations better. An efficient community facilitator should have the skills and ability to work in collaboration with the institutions in the community, for example the doctors, nurses and Auxiliary Nurse Midwife (ANM) at the Primary Health Center (PHC) and the Aanganwadi (community) workers, teachers and Balwadi (primary school) workers at the school level.

Activity 7:

BRAINSTORM on Community Facilitator

Guidelines for discussion:What qualities should the community facilitator have?What are his/her roles?How can we identify a community facilitator?What methods can be used to identify or involve a community facilitator in DMH/PC activities?

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A Community facilitator must be:

• person from the community affected by or at risk in disasters.

• experienced in working with the community.

• recognized and trusted by the community.

• sensitive to the beliefs and traditions of the community.

• with spirit of voluntary service.

• leadership capability.

• communications skill.

• open to new ideas.

• basic knowledge of mental health and disasters.

The Community Facilitator has the abilities and skills for:

• Communication.

• Vulnerability and Community mapping.

• Community Organization

• Conducting of group meetings.

• Dissemination of educational material.

The Community Facilitator has knowledge of:

• The contents of the mental health training modules and mental health intervention programmes for people at risk or affected by disasters.

• Knows how to conduct community mapping and develop physical and emotional assessment among different groups in the community.

3.2 COMMUNITY FACILITATOR’S ROLE IN GROUPS (Refer Annex 1.4):

The community facilitator has the responsibility of bringing different groups in a community together. He/she has to be able to represent the interests and needs concerned with the mental health and psychosocial support of each group. In this process, the community facilitator will become part of forming and organizing group meetings.

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The specific tasks community facilitator has to perform are:

• ensure that the participants are clear about what they want to achieve.

• direct and stimulate teamwork and emphasize the strength of collective action.

• foster a trusting and friendly environment with respect to individual privacy and confidentiality.

• see that the agenda is followed and that members do not get diverted from the main topic.

• encourage members who are not very participative.

• control and maintain order and the norms decided on by the group.

• direct the meetings towards reaching conclusions and commitments.

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Activity 8:

Community facilitator’s role in groups :

The participants are divided into two groups, each representing the community of two neighbouring villages. Four participants are made to stand in the center holding hands to form a square. This represents a pond. One participant takes on the role of a facilitator. Two ropes are given to the groups. They are to mark the boundary of their villages. They both try to include the pond in their territory. There is pressure from both sides on the four in the center, causing them to go off balance. Facilitator steps in to discuss how both the sides can enjoy the benefits of the pond.

[Refer to handbook module 1 Q.No. 6 ( A & B), Q. No. 7 ( A & B ).]

3.3 Other Responsibilities of the Community FacilitatorThe community facilitator promotes and leads mental health programmes in his/her community. He/she is responsible for all individual and group level activities. ( refer Annex.1.3)

4. Conflict and Conflict ResolutionWhat is conflict?It is the quarrel and clash of interests, differences of opinion or lack of understanding between two or more people. Conflict often occurs when people are trying to work towards some common goals. The community facilitator should be aware of the possibility of conflicts when he/she is working with groups. Very often, differences of opinion with other people, with friends, even with members of our own family arise in our daily lives; therefore it is important to learn how to identify the conflicts, manage and resolve them in order to improve our social, personal and family relationships. Conflicts are not easy to solve due to the difficulties, complexities and variations in the interpretations of ideas, concepts, way of thinking, customs and behaviour.

Conflict arises when:

• We do not listen to what others are saying.

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• We do not recognize what another person is experiencing and how he/she is responding to a situation.

• Our effort to be supportive is perceived as inappropriate.

And when there is.:

• Difficulty in communication leading to misunderstandings.

• Absence of dialogue.

• Excessive aggression.

• Dishonesty.

Conflicts are caused due to misunderstandings, which go out of control, and people are not able to differentiate between reality and their own perceptions of the situation. In India, many caste confrontations are caused due to minor events, which develop into violent situations due to misunderstandings, rumours, prejudice and wrong perception.

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Activity 9:

Role play, put an end to conflict:Make three or four groups of participants.Give a proposal to install a tube well in a community.Each group has to give their own suggestions about a suitable place in the village for tube well installation.

Brainstorm: On conflict (conclude on conflict resolution)

Guidelines for Group discussion:Have you ever had a fight or disagreement with someone? What was the issue?Have you ever helped someone resolve a fight/disagreement with another person?What are the reasons for disagreements?What reasons do you see for disagreements to arise in the community?

Sharing of experiences during the discussion

How can we resolve conflict?

• Accept the person. You don’t have to accept the behaviour.

• Correct inappropriate behaviour before it becomes a trend in the interaction.

• Express your feelings if you are uncomfortable with a person’s behaviour.

To avoid conflict, we must:

• Understand feelings

Be in another person’s shoes and try to see his/her viewpoint. • Be sure of oneself

Say what you think or feel without hurting the other person.

• Be able to adjust with different situations and people

Be tolerant, sympathetic, friendly, forgiving, impartial and supportive.

• Know your faults and virtues

Be aware, that each one has his/her own ideas and thoughts, and accept our mistake acknowledging the fact that we are not perfect. This helps in changing our behaviour for the better.

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• Be polite

The pleasant and friendly approach helps us make friends.

[Refer to handbook module 1 Q.No. 8 ( A , B & C)]

5. CommunicationWe exchange spoken and written words, facial expressions, gestures, body postures and tone of voice Communication is a method by which channels of interaction are opened between people.

Activity 10:

EXERCISE: Non – verbal communication

Four participants are selected. They are given four different cards with four different emotions written on them e.g. happiness, sadness, anger, jealousy. Then each one is asked to demonstrate the emotions respectively. After the participants finish, the group is asked to guess who enacted what, and how they recognized the emotions.

Message conveyed – The importance of Non-verbal gestures in communication and the importance of response through keen observation.

Communication comprises three important aspects:• Seeing/Observing: The person’s body language, eyes, way of speaking etc.

• Listening: To what the person is trying to tell you and responding accordingly.

• Making physical contact (when appropriate): Making contact with the person. It can be a pat on the back, a hug, and slight touch of hand etc.

Components of communication:• We are always communicating verbally or non-verbally. While dealing with others

we communicate by speaking as well as by remaining silent.

• Our body posture and gestures will help us to communicate better. Non-verbal cues give out subtle messages, which may or may not be intended.

• Communication has content and relationship; the content is what we say, the relationship is the way we say it. For example, “I agree on participating in the meeting, but I do not like the way that some people talk to me.”

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• Communication can be positive in giving positive feedback rather than negative, and by making positive reinforcements in public and in private. It should foster collaboration that allows people to work together and combine skills and resources.

• It is important, that our communication is clear and precise. Although sometimes it is difficult to communicate what we actually want to express due to fear, habit and tradition.

• Communication encouraging the positive aspect of a negative experience (e.g. possibility of a productive life ahead) is always more helpful to a disaster survivor instead of over-emphasizing the fact that he/she is a disaster survivor.

5.1. Verbal and Non-verbal communication: The way, we send messages through our eyes, hands and body movements along with what we speak is called verbal and non-verbal Communication.

Certain body signs also communicate certain things about a person. Thus, what we say is as important as how we behave because our actions also send out subtle messages to the person we are trying to communicate with.

For example:

a) Not maintaining eye contact during conversation indicates that the person is not interested or is thinking about something else.

b) Touching the lips, looking upward, head lowered towards the chest indicates that the person is in a reflective mood.

c) Red face, high tone of voice, pointing with finger, arms and legs crossed, forehead wrinkled indicates that the person is irritated or very angry.

These are some general examples, but different individuals have different ways of telling each other their state of mind. People, who are close, like two good friends or husband and wife, are able to guess when the other is in a bad mood, through their body language.

Similarly, when two people do not know each other and meet for the first time, body language helps them to develop better understanding of each other along with the spoken words exchanged.

5.2 Listening and respondingCharacteristics of a good listener:

• Listens to each word carefully.

• An active listener responds non-verbally by nodding, affirming etc.

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• Listens and look for the feelings and basic assumptions underlying the remarks.

• Good listener does not interrupt, especially to correct mistakes or make points.

• Doesn’t judge.

• Mainly ask open-ended questions. E.g. “So how are you feeling today? How was your day?”

• Interprets the total message through words, body language and facial expressions.

• Pays attention to the message.

• Is careful with what you are saying as words can often be a source of misunderstanding.

• Encourages the person to express all his/her ideas without repressing him/herself.

This module is focused on providing guidelines for the community facilitator in terms of the skills requires and of his/her role in community. It emphasizes the importance of leadership and communication in bringing about community participation among different individuals and groups. It also attempts to increase the knowledge of the community facilitator about Red Cross and the Sphere standard of mental and social aspects of health. Although the community facilitator’s role is a dynamic one, it is broadly outlined in this module thus enabling him/her to have better understanding of his/her responsibilities.

The following module provides the basic concepts of Disaster Mental Health and Psychosocial Care (DMH/PC) to enable the community facilitator to understand his/her work in the community. It provides him/her skills to carry out needs assessment in the community from a DMH/PC perspective.

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Post TestAnnex 1.1

Module 1: The Role of a

Community Facilitator

PRE/POST EVALUATIONName:____________________________________________Date: ______________

Institute/organization to which he/she belongs:____________________________

Place:_______________________________________________________________

Indicate the correct answer with a tick mark (√)

1. Role of a leader:a. To make all the decisions.b. Not to interfere in the group process.c. To force the group members to participate.d. To identify skills and maturity in the group members.

2. Communication means:a. Sharing of experiences.b. Speaking and listening.c. Using verbal and non-verbal language.d. Letting the other person talk.

3. The community facilitator is:a. The sarpanch in a village.b. A trusted person who understands the village.c. A person who can work in groups.d. A red cross volunteer.

4. Verbal and non-verbal language involves:a. Active listening and responding.b. Communicating through words, and body movements, eyes and expressions.c. Talking to people.d. Remaining silent when talking to someone.

5. A community is:a. Two or more peopleb. Groups having common factors.c. Sharing, participation and fellowship.d. All of the above.

6. Two principles of Red cross are:a. Tolerance b. Helping others c. Humanity d. Neutrality

7. The Sphere Standard of mental and social aspects of health refers to people having access toa. A minimum package of services to prevent transmission of HIV/AIDS. b. appropriate services for the management of injuries. c. services to reduce mental health sickness, disability, and social problems.

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Annex 1.2Steps for participative planning:1. Take opinions of groups in the community on common problems and possible

solutions.

2. Participative planning helps to make action plans for the community. The planning is done after discussions between different groups in the community who are present and who have made their priorities clear.

It Involves:

1. Identifying the main problem: Here members of different groups get involved in discussing the problems faced by the community. The main goal is to decide an approach to solve this problem.

2. Proposing alternative solutions: This allows the organization to discuss the alternatives solutions to address the problem. These are the objectives, which will help to fulfill the goal.

3. Identifying the resources: This includes making a list of the various things that exist in the community, which can be used. The resources are material, physical, human or financial.

4. Describing the activities: This involves planning the specific actions, which will be used to fulfill each objective.

5. Allocation of responsibilities: This includes deciding the people who will be responsible for fulfilling the tasks.

6. Deciding the time period: This involves deciding the period within which the planned activities are to be completed. This is a very important component of the action plan.

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For Example:

A Community Action Plan

STEPS RESULTS

1. Diagnosis and analysis of the problem: Distressed children in the community after a disaster.

We will understand the problem better.

2. Define goals: Care and support for children after a disaster.

We will be clear about what we want to achieve.

3.Define objectives: 1. Selection of children and families who

have been severely affected.2. To improve the family atmosphere through

different interventions with attention on psychosocial support and mental health.

Clarity of path, to achieve what we plan to.

4. Define activities: Organizing picnics and drawing for children.

Things/tasks that we need to do amongst us.

5. People responsible: The Aanganwadi worker or the teacher.

People who will be in charge of each activity.

6. Resources: 1. The contribution of the community to

organise the picnic.2. The premises for the picnic.3. Pens, paper, pencils, crayons for the

drawing.

We know who will work, physical and financial resources available and what we need to do to get them.

7. Establish time-lines: 1. Picnics in the month of May 2003

Timeframe within which tasks/activities must be completed.

8. Follow up: Meeting the children every week in the school building.

Make sure that all the specified tasks/activities are completed.

9. Evaluation: Ask the children what they felt after the activities.

Verify what we have achieved.

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Annex 1.3How a community facilitator can fulfill his/her objectives…

A. ASK THESE QUESTIONS:

1. What are the problems of individuals in the area I work ?

2. What are the problems of the community in the area where I work ?

3. What are the efforts made by me during my fieldwork ?

4. What are the problems faced by me ?

5. Who are the people I am able to help ?

6. Who are the people I am unable to help ?

7. Who are the people I have referred to various agencies?

B. Write a detailed illustration of your field experience in the month.

For example,I worked with ……………………………………………………….people this month.

I helped…………………………people through my experience and knowledge.

The community needs are:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

I feel satisfied with my work this month because…............................................

MY NAME

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Annex 1.4 You might have these problems when working in groups:1. What to do, when people do not participate ?

If there is lack of attention is from a participant who is causing disturbance to the rest of the people, wait till there is a break or till the work session ends before you speak to this participant in private. Ask him/her calmly and in a friendly manner so that the person is honest with you.

If the lack of attention is disturbing the whole group, you can ask the person politely for an explanation in front of the group.

2. What to do when the whole group is not participating?

It could mean that the way you are facilitating is boring or tiring or the activities are too complicated or simple. To prevent this, we recommend that you plan activities that have movement, which are of the level of the group, which lead to healthy discussion without hurting anyone’s feeling or humiliating people.It is also suggested that at the beginning of each session, you present the topics you plan to discuss and the activities.

3. What to do when the group ‘attacks’ you ?

To avoid this situation it is best to clarify in the beginning that the entire group is responsible for the success or failure of the group. If the group expresses dissatisfaction:• Allow them to express their frustration, anger, and disillusionment.• Try to direct the problem away from personal attacks and focus on the problem the

group decided to meet for.• Guide discussions towards finding solutions.

4. What to do when there is not enough time to do all that you had planned?

If our work agenda is longer than the time available:Establish an order of importance. We will deal with the most important and necessary items first and if there is time left we will work on the other points.

Have two or more meetings to work on a topic.Once the agenda is adjusted to the time available, right at the beginning of the meeting ask someone in the group to take the responsibility of controlling the time. It is possible that while you are working, you are so busy or involved in directing the group that you may forget the time you have for each activity. This person will remind you, in case it is necessary, about the time you have available for the activity that you are doing. This does not mean that the person will not

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participate in the group activity. Tell the group when the time limit established for each activity has been reached or passed and ask whether they want to continue or stop.

5. What to do when opinions are different and they end in battle about ‘who is right’ ?

Focus the discussion on the problem at hand and its effect on the group and not on one individual.

Remain neutral. Don’t take sides.

Stop the discussion. Ask questions to each of the parties and ask them to clarify their doubts or problems.

Remind the group that they should remain neutral and respect the opinion of each member and listen carefully.

Let each member share what he or she understood of the problem and their suggestions for resolving it.

6. What to do when an exercise or an activity fails?

This could be due to any of the following reasons: • When the activity does not take place the way it was planned.• When it takes place as planned but the group destroys the meaning of the entire

activity.

What to do?• Admit in front of the group that the activity has failed.• Identify with the group that what were the causes leading to the failure of the

activity and thus, avoid a future failure, for e.g., clear instructions were not given, we didn’t want to participate because it seemed silly to us etc.

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Session Guidelines to Module- I

CONTENTS ACTIVITY SOURCES DURATION

Introduction about Red Cross and Sphere Standard of mental and social aspects of health.Introduction to Module- l

WELCOMEParticipants Introduction(Remembering the name)Presentation andBrainstormPresentation of module- l

Activity 1Paper, pencil, folders.

15 mins

30 mins

10 mins

PRE TEST Annex 1.1 20 mins

1. Communities and groups.2.2 What is a group ?2.3 What is community ? 2.4 What is community participation?

Exercise: Introduction with playing cards – similarity in each pair.(Conclude on groups)Brainstorm: GroupsBrainstorm: CommunityExercise: Passing theGlass Group discussion:Community Participation

Activity 2

Activity 3

20 mins15 mins

15 mins30 mins

2. Who is a leader ?2.5 Qualities of a leader2.2. What is situational leadership?

Exercise : Helping blind men (ConcludeDefinition)Brainstorm : QualitiesExercise : Rope game-Leader to help (Conclude)Lecture

Activity 4

Activity 5

20 mins

20 mins

15 mins10 mins

3. The community facilitator.2.6 Who is a community facilitator?2.7 Community facilitator’s role in

groups.2.8 Other responsibilities of the

community facilitator

Brainstorm

Lecture

Activity 660 mins

40 mins

4. Conflict and Conflict resolution.

Exercise: Role playTube well (concludeOn conflict)Brainstorm: on conflictGroup discussion :On conflict resolution (conclude)

Activity 7

60 mins

5. Communication.5.1.. Verbal and non-verbal communication5.2 Listening and responding5.3 Sharing thoughts : Feedback & disclosure

Lecture

Brainstorm:

Brainstorm:

Activity 830 mins

30 mins

30 mins POST TEST Annex 1.1 20 minsTOTAL HOURS 8 hrs 10 mins

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Objective: Increase the Community Facilitator’s knowledge of Psychosocial Support.

Expected Outcome: The Community facilitator will be able to identify: • five common factors and common responses to every disaster• three factors that define psychosocial support • five protective and risk factors in the community and• prepare community map of the affected community.

2Psychosocial Support in Disasters

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Describe a disaster. Discuss common reactions to it. Move on to talking about Psychosocial Support with examples. Identify protective and risk factors in the community. Develop a map of an affected community with these points in mind.

PRE TEST (Annex 2.1)

1. What is disaster?A disaster is an occurrence disrupting normal conditions of existence and causing a level of suffering that exceeds the capacity of adjustment of the community.

A disaster is an event that:• is beyond the community’s capacity to respond,• affects humanity with loss of life, livelihood and property, illness and injury,• destroys social structures like offices, schools, road links,• brings about scarcity in essential needs such as food, shelter, clothing,

medicines.

Eg. Gujarat earthquake.

Activity 1:

Brainstorm on disasters.

What do you understand by a disaster? What happens? Why? Have you experienced any? Is your village prone to disasters?

1.1 Types of Disasters Disasters are either natural or human-made.

Natural disasters are caused by natural forces. They come without warning. They are often unexpected and unavoidable. Earthquakes, cyclones, hurricanes, volcanic eruptions are natural disasters. They cannot be controlled. But floods, droughts, landslides can be avoided or reduced by civil works such as dams, planting of trees and also by disaster preparedness planning.

Human made disasters are caused by human neglect or carelessness. They too are unexpected. They can cause great damage to life and property. Sometimes they have long lasting psychological and physical effects. Accidents, fires, blasts, pollution, wars, riots are some examples.

Introduction

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Natural Disasters Human made disasters Floods RiotsEarthquakes WarsLandslides Industrial accidents Droughts Accidents (road, rail)Cyclones TerrorismStormsHurricanes

Activity 2:

Make a few cards with the various disasters written on them. Distribute these cards among the participants. Tell them to identify whether they are natural or human-made disasters.

Brainstorm on types of disasters

1.2. Phases of Disaster:

Event: is when the disaster is taking place. Response: is when relief and rescue operations are on. Rehabilitation is the time taken to complete the task of rebuilding community’s confidence, returning of survivors to their homes or finding new homes if the former are destroyed.Reconstruction: is the period when people are helped to organise themselves for the prevention of such disasters, equipping them with well-planned preparedness.Prevention and mitigation: is the long term process of strengthening the existing protective factors and lessening the risk factors in the community and the area concerned.

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Activity 3:

On Community response to disaster

Except for one, all participants stand in a circle with their hands held above. The person left out comes and pushes one participant from the back. This results in some or all of them falling. Some stay down. Others get up with help. Each one responds differently. Some quick, some lethargic. Ultimately with help, all of them get back to their standing positions.

Activity 4:

This is to demonstrate community’s response to a warning.

Divide the participants into two groups. Place two ropes on the floor in between them to demarcate a river. The space on either side, between the river and the participants, is “land”. When the instructor calls out “river”, the participants are to jump into the ”river” area between the two ropes. When the instructor says, ”land”, the participants are to stand between the rope and their own positions ,which is “land. The instructor will give the orders and the participants are to follow them instantly. This will show the alertness of the participants and their capacity to react instantly. There will be confusion and fun, but the point will be well made.

Activity 5:

Check for preparedness.

Except one, all the participants are to join hands and form a circle. The one left out is to quietly slip into the centre of the circle without the others being aware. This will be brought to their notice. An outsider can get in only if they are not vigilant. Next time the outsider tries to enter the circle, he cannot. The hands forming the circle are held firm. They are prepared.

2. What is Psychosocial Support ?Psychosocial Support is a program that prepares the community to be emotionally equipped to respond to disaster.

It includes support and care activities that bring the people of the community together and build a network between organizations that work in the area.

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The duration of psychosocial support activities can be between four weeks and three years. It’s a long term process covering the rehabilitation and reconstruction phases.

Psychosocial Support Activities:• Crisis Intervention: helping the survivors, cope with the problems caused by the

unexpected crisis.• Build Social networks: connecting all the social organizations within the community

to share their ideas and knowledge for the benefit of all.• Support Groups: to help survivors share their feelings, emotions, experiences.• Training: for volunteers and members of the community to carry out DMH

activities.

3.Common Reactions to Disasters:Reactions to a disaster are normal reactions to an abnormal incident.

“Most disaster survivors are healthy people who fulfil the responsibilities and solve the problems of day-to –day living. However, a disaster event tends to disturb this fine balance and puts them through an emotional and psychosocial upheaval.”(Myers, 1994)

Activity 6:

On various reactions to disaster Cards with different reactions written on them are distributed to the participants. They have to identify which are the negative and which are the positive attitudes.

The common reactions to a disaster or crisis situation are :

• Shock, disbelief and denial - I can’t believe this is happening to me

• Fear - I’m scared of the dark;

• Anger - Nobody’s doing anything for us

• Confusion – I don’t know what to do.

• Guilt - If only I were at home then, I could have saved….

• Shame – I can’t beg for relief material

• Grief - All our joys have gone

• Disorientation – I don’t know where am I , who is this man and what time is now?

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3.1 What is a Crisis?

A crisis is:• A personal disaster.

• Anything which goes beyond a person’s coping capability at that given time.

• It affects everyone.

• Has a different personal reaction.

• It could have a negative or positive outcome. It is very important to remain positive throughout and make the best of the situation.

3.2 What is Loss and Grief?

What is loss?• It is the suffering caused by the permanent absence of someone or something very

dear to us.

• There are three kinds of losses. Emotional, physical and material.

• Emotional Loss – Death of a loved one. Loss of faith (especially after riots/wars), identity, trust, hope.

• Physical Loss – Loss of limbs, physical ability, memory, physical appearance (because of severe injuries, burns).

• Material Loss - Loss of property, money, home.

What is Grief ?• It is a combination of sadness, fear, hopelessness and anger.

• Grief brings on a change in everyone.

• While recovering from loss it is normal and healthy to grieve.

• Sharing memories and expressing feelings of sadness helps overcome grief.

3.3 What is Stress ?( Bryce 2001)• It is the way the body responds to a situation that is different from a daily life

situation. For example, organizing a marriage ceremony can cause sleepless nights for the family members.

• Stressor is the event that makes our body respond. For example a farmer is not able to sleep, eat, well or fulfill his daily chores because the rain is delayed. That is a stressor.

• His inability to sleep and eat is the way his body is responding.

• Stress is caused by constant worries in daily life. Where will the next meal come from? No money to buy food. The children are unwell. Stress can cause illness.

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Here are some stress reactions

BehaviouralSleeping problems, crying easily, avoiding remainders, feeling alone or social withdrawal, increased conflicts with family.

Affective (emotional)Depression, irritability, fear, anxiety, hopelessness, guilt feelings, self –doubt, changing mood frequently.

Somatic (Physical)Heavy sweating, headaches, loss of appetite, tiredness, pain in the muscles and chest, excessive activity level.

InterpersonalHelplessness, withdrawal, difficulty in sharing, guilt seeking help from family and community members.

CognitiveConfusion, disorientation of place, person and time, nightmares-bad dreams, trouble concentration, difficulty in making decisions, preoccupation with disaster.

Activity 7:

On stress –an artist’s attempt

A participant is asked to draw on the board. Others are quietly instigated to disturb him/her with various suggestions. The artist can’t continue in peace. Gets stressed.

Brainstorm on stress

Activity 9:

Energiser Three participants are chosen and given three cards –(1) has dog written on it,(2)cat, (3) lion. They are the leaders. The other participants are to choose any of these three numbers. They are grouped accordingly. Each group is made to stand in a different corner of the room. They are then asked to make the respective calls of the animals and reach their leader. This makes them stress free.

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4. Mental Health in the CommunityTo promote community mental health, one has to identify the weaknesses in the community that may cause mental health problems and also strengthen the factors which will increase the capacity to respond positively.

4.1 Protective and Risk FactorsA community has certain physical and psychological factors which either makes it more vulnerable during disasters or more capable of handling the situation. The positive are the protective factors. The negative ones are the risk factors.

Protective Factors Risk Factors

These are the strengths in the community.

These are the weakness in the community.

The factors increase the community’s capability to respond physically and emotionally to a disaster or to recover from a disaster.

The factors make the community more vulnerable to a disaster and decrease its capability to adapt to its aftermaths.

Protective factors and risk factors can be identified by the availability of the following information:

• Geographic location (distance from epicenter, open field canal)

• Past experience (how well it has dealt with crisis situations before)

• Communication infrastructure (Vehicles, roads, closeness to hospitals)

• Social bonding in community ( Number of Self Help Groups)

• Community resources (Teachers, doctors, Aanganwadi workers)

Activity 10:

Group Work:

Participants are to be divided into groups. Each group will represent a village. They are to figure out their strengths and weaknesses, and present their case. The leader of each group (chosen by members) will make the presentation.

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4.2 The Importance of Needs Assessment (iden-tifying protective and risk factors)• For the community to be aware of its strengths and weaknesses and prepare

accordingly.

• For the community Facilitator to be able to work on the weaknesses and develop the strengths.

Methods to be used:• Observation: Meet people of the community and identify vulnerable groups.

• Interview: Personal contact on a one to one basis. Get to know them closely.

• Individual surveys: Of the population in the area.

• Group surveys: Of the affected community.

• Reports: From government and non-government agencies who may have done prior assessment in the area.

Assessment of Post –Disaster Stress Reactions You can ask these questions in one to one contact:• Do you have trouble falling asleep ?

• Do you have repeated disturbing dreams about the event?

• Do you become very upset or experience heart pounding or difficulty in breathing when you are reminded of the event?

• Do you avoid thinking or talking about a bad experience related to the event?

• Do you feel distant or isolated from people?

• Do you feel that your future is dark and there is no hope?

• Do you get irritated/angry very easily now?

• Do you feel easily startled by small noises?

Activity 11

Role play:

Two participants will come voluntarily to act. One participant will ask at least three questions mentioned above to the other one. The other participant‘s task is to either answer the question verbally or can show the response by acting. Similarly, other participants will come forward to complete all the questions mentioned above. Finally, all the participants will discuss on it.

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4.3 Information to be gathered for Community Map:

Pre-Disaster Post-Disaster

1. Population and demographics of (people, number of men, women, children, elderly)

• Number of families who have lost an earning member, number of injured and dead.

• No of widows, orphans and single women.• No of elderly injured, dead.

( i ) No of people with chronic diseases. ( ii ) Identifying people with non-adaptive

behaviors. For e.g., increased use of alcohol, increased violence in families.

2. Number of people suffering from mental and physical disability.

No of people with physical and mental disabilities injured, losses suffered.

3. Transport and communication (condition of roads, number of vehicles).

Loss of communication, condition of roads, means of transport to hospitals and nearest town.

4. Number of houses in the community.

Extent of damage to property.

5. Location of school building, PHC, Talati’s office.

Extent of damage to school building, PHC, other structures.

Activity 12:

Group Work on Community Mapping (Refer: Annex 2.2)

5. Prevention in Mental Health: (Cohen, 2000)‘Prevention’ refers to the means adopted to avoid disaster or crisis and be prepared before it occurs.

• Mental health prevention activities prevent a community from suffering acute emotional problems after a disaster. It helps a community to be better prepared to respond to a disaster or crisis event.

• Refers to activities which can contribute to positive mental health in community.

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5.1 Primary Prevention:• Primary prevention involves activities which will prepare the community to respond

to a disaster.• Its purpose is to reduce the risk factors and strengthen protective factors of the

community and help it to meet its emotional needs.• It requires the co-operation of different groups in the community and the

organisations working within it.

Primary Prevention Activities of Mental Health• Community mobilisation for bringing groups together.• Participatory needs assessment for finding out strengths and weaknesses, protective

and risk factors.• Training to teach community members how to carry out disaster mental health/

psychosocial care activities.• Mental Health promotion activities distribute information on DMH to community

through media.

The responsibility for primary prevention lies with:Primary Health centers, primary and secondary schools, Municipality at village level, Panchayat, support organisations within the community (balwadi, Aanganwadi), district administration (BDO’s office, Collector’s office) general public.

5.2 Secondary prevention:Strategies used by the community and skills acquired to deal with disaster situations in a better way before, during and after the event.

Some secondary prevention activities are• Techniques of stress management and self care• Building of social groups and social networks.

5.3 Tertiary preventionLong term strategies to strengthen a community’s abilities to respond to crisis, with focus on providing psychosocial support and building resilience within the members of the community.

Some tertiary prevention activities are:• Facilitating meetings of community groups• Conducting workshops on self care and free expression• Conducting stress management activities.

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PRE/POST EVALUATIONName:____________________________________________Date: ______________

Institute/organization to which he/she belongs:____________________________

Place:_______________________________________________________________

Mark with a cross (X) the correct answer:

1. Mental Health is:

a. To have a mental disease.

b. A concept not related with development.

c. A state of well-being that influences our capacity to respond.

d. To avoid daily life problems.

2. What is Disaster Mental Health ?

a. Number of people going mad after a disaster.

b. Activities that reinforce pre-disaster adaptive behaviours.

c. It is a punishment of God.

d. It is the damage caused by a natural or human-made phenomenon.

3. A Protective Factor can be:

a. A casual event.

b. A traumatic experience from the past.

c. The opportunities of each individual.

d. The strengths of the community.

4. A Risk Factor can be:

a. Insufficient support factors in the community.

b. An accidental circumstance.

c. Training to face disasters.

d. Stress.

5. What is Needs Assessment ?

a. Counting number of families.

b. Finding out needs of vulnerable people.

c. Identifying the protective and risk factors in a community.

d. Finding out the number of dead in disasters.

Post Test(Annex 2.1)

Module 2: Psychosocial

Support in Disasters

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6. What do you mean by “BASIC” of stress reactions?

a. Basic needs

b. Basic knowledge about stress

c. Physical factors of stress

d. Behavioural, affective, somatic, interpersonal and cognitive reactions. 7. Who are responsible for primary prevention in mental health?

a. PHC at the village level, municipality, the Panchayat and District administration.

b. Red Cross, st.Johns ambulance and state disaster committee.

c. All the community people

d. All mentioned in a, b and c.

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EXAMPLE OF A VULNERABILITY MAP

Annex 2.2

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Objective:Promotion of Psychosocial support before, during and after a disaster.

Expected Outcome:The community facilitator will be able to:• Identify two ways in which psychosocial support promotion can be carried out in

the community.• Prepare and distribute materials for psychosocial support.

3Promotion of Psychosocial Support

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Discuss promotion of mental health and disaster mental health. Describe ways in which disaster mental health promotion can be carried out in the community. Prepare disaster mental health promotion material for the community.

PRE TEST (Annex no: 3.1)

1. Promotion of Psychosocial Support in Disasters.

1.1 What is promotion of Mental Health ?Mental health promotion is both any action to enhance the mental well being of individuals, families, organizations and communities, and also a set of principles, which recognize that how people feel is a significant influence on health (Friedli, 2000).

Introduction

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1.2 What is promotion of psychosocial support?Psychosocial support promotion is the strengthening of social bond before, during and after a disaster. It informs the community of the relevant factors of psychosocial well being. It educates them on how to deal with this behaviour pattern and communicate this information by various methods.

The topics include:• How individuals, families, organizations and communities feel before, during and

after a disaster?• The factors which influence how they feel. • The impact of this on overall health and well-being of the community and

individuals.• How the community and individuals can deal with their feelings before, during and

after a disaster.

(Refer to Handbook Q.No.1. Govind in the midst of a drought)

Promotion can be carried out in the community:• When the community works together (community organization and

participation). • Distribution of information about what is psychosocial support and what to do in

a disaster situation.

Activity 1.

Participants are given information on awareness regarding polio or HIV/AIDS. They are then asked to present any form of mental health promotion they think fit for any other problem /crisis situation.

This is followed by a Brainstorming.

1.3 Psychosocial Support promotion includes: o Information: n psychosocial support promotion work it is important to give accurate

information regarding the disaster event, relief, losses suffered and about all the survivors.

E.g. number of injured, where to receive relief material from, psychological and physical first aid etc.

o Education To promote psychosocial support, it is necessary to educate the people in the community that reactions to a disaster event are normal in abnormal situations. Education about disaster responses should be aimed at changing the attitudes of individuals and communities and bring about an understanding of the relevance of psychosocial support in disaster.

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E.g. How do children respond to a disaster event ? What can we do to support our children during and after a disaster ?

o Communication To emphasize that communication channels have to be formed. The clearer the communication within the community, the better the adaptation.

E.g. deciding on the kind of relief and services are needed by the community for different kind of disaster.

(Refer to HANDBOOK Q.No. 2 Train Accident.)

2. How can we promote psychosocial support?The topics related to psychosocial support affect all members in a community. Therefore, it is required that all members and groups in a community work together and discuss their problems amongst each other. Together, they can identify positive messages for psychosocial support and decide on how to distribute them amongst the community.

Promotion activities in the community should involve:• The organization.• Social network.

2.1 What is an organization? 1. A place where members of a group or community come together. 2. With specific objectives and activities to perform. 3. Represent the best interests of its members/community.

Characteristics that the organization should have:o Open communication. E.g. the people of the group should be able to talk about

their ideas, comments and opinions with each other.o Ideas of its members must be valued. Each and every member in a group is important

and so is their contribution.o Encourage discussion of new ideas. Psychosocial support activities have to be

appropriate to the culture and circumstances, and there is not one formula that can be applied everywhere.

o The leaders don’t dominate and everybody should be able to share thoughts and opinions. The leader’s responsibility is to make sure that everybody has an equal share of rights and duties in the group.

o The decisions are taken with the participation of all the members.

(Refer to Handbook Module III Q.No. 3 Self Help Group.)

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Different Example of organizations are:• Parent groups• Health groups. • Youth Clubs• Sports Clubs• Religious groups• Women’s groups• Local committee for community development.

(Refer to Handbook Module III Q.No. 4 Anti-malaria campaign.)

2.2 What are social networks ?• Different organizations and institutions in the community working together on

similar problems of the community. • They are interconnected by combined work. • They work for a common purpose.

E.g. the local psychosocial support committee and the adolescent support group working together on the issue of alcohol and substance abuse during disasters.

Activity 2:

Broken square - Four cards will be cut into four pieces of various shapes. These pieces will be shuffled. Each participant will be allowed to take four pieces. They will then be asked to form a square with the pieces that they have. Strict silence is to be maintained. To make a square successfully they have to network with the others.

Guidelines for discussion:a) Identify the different organizations in the community?b) Do these organizations work together?c) How helpful do you think they are?d) Identify five areas in which they can be more helpful?

(The discussion will bring forth the importance of networking between different organizations within the community.)

(Refer to Handbook Module III Q.No. 5 Caste war.)

Social networks are important in a community because:• They help community to develop when information about similar work is

shared between different organizations. For e.g., the mahila mandal• and the health team working together on medical assistance to widows in the community.

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• Work to reduce stress in situations like a disaster.• Help in mobilization of resources such as medicines, food and transport. • Increase the knowledge of the community on issues of disaster mental health. • Encourage greater planning and organizing of psychosocial support activities.

3.3 Local Committee of Psychosocial Support (Refer Annex 3.3):

A local committee of psychosocial support is: A body of people from different groups who will promote psychosocial support in

the community. They will form social networks with other organizations in the community.

These are the tasks of the local committee:

• Decide what steps it will take before, during and after a disaster to meet the immediate material and emotional needs of the people.

• This includes questions like what to do, whom to assist, whom to contact for help and assistance and how to contact.

• Identifying the emotional needs of the different groups in the community.

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Activity 3.

ROLE PLAY

Duration: 60 minutes

Procedure:• Divide the participants into smaller groups.• Brief each member in each group about the roles that they have to

play. E.g., each member will have to represent a group (such as women, elderly,

caste, non-caste, Hindu, Muslim) from the community. • Present a case scenario (e.g., an earthquake has struck the village and

everything is destroyed).• As the groups discuss, they will make points based on what they have

learnt about planning psychosocial support activities.

Guidelines for discussion:• What are the problems faced by the different groups (women, elderly

etc.) in the community ?• What psychosocial support activities should the local committee organize

to address the needs of the different groups ?• What are the things they will require to carry out these activities?• Whose help will they seek in carrying out these activities ?• Who will be responsible for the specific tasks to be completed ?

3. GUIDELINES FOR PROMOTION:When planning on how to promote or working out the activities, the local committee must discuss the following questions:

3.1. What is a target population ?• Who are the people who are going to be addressed?• What are the characteristics of the community you want to address ?• What is the level of education among the target group ?• What is the level of information they have on psychosocial support?

3.2. How to identify the main theme?The theme of promotion is the main issue in psychosocial support on which activities will be planned.

E.g. what can be Psychological First Aid (PFA) or stress management or self-care techniques?

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To decide the main theme the following questions should be considered:• What are the main problems faced by the community after the disaster?• What are the needs of the community? • What are the main problems that you want to focus on? • What are the types of disasters experienced in the last three years?• Which is the affected population?• How should the message be sent ?

3.3. What will we use ?• Do we have money or other things that may be needed?• Do we have people who can do the work?• Do we have volunteers who will help?• Where will we organize the activity?

E.g., if a campaign on PFA is being organized, does the community have people who can make posters and flyers? Are there people who will be willing to contribute? Is there a community hall where activities can be conducted?

3.4 Types of messages in each phase:

PHASESEmergency phase(Pre-impact)

Immediate aftermath (impact)

Early post-impact Rehabilitation

COMMUNICATION Warning about the disaster

Information to control rumours about the disaster.

Information about the preventive measures that can be taken

Information to increase confidence to reduce fear and anxiety

Information about the resources available

Offer basic information on psychological first aid(meeting immediate needs of food, water, shelter and medication, listening and supporting, link with family)

Information to clarify rumours

Information to encourage:

Village unity to face community crisis

Pro-social behavior

Unity among community members

Working together

Participation of different groups.

Linking to support groups

Working among different groups

Provide information about:

Resources,where to go and whom to meet for help and assistance

Social networks

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Activity 4.

On Rumours. The class is made to sit down. One person is made to whisper a statement about an incident to the neighboring person. S/he will have to pass on the whispered message to the next person. This carries on till the circle is complete. The last person is asked to repeat the message. It is compared to the original message. Discuss on how message must be clear and effective. Wrong messages give way to rumours. Facts must be precise.

3.5. Preparation of Messages (Refer annex no: 3.2):

Messages should be:1. CLEAR AND SHORT2. SIMPLE LANGUAGE3. USEFUL INFORMATION4. REFLECT THE NEEDS 5. DRAWINGS.6. COMMUNITY METAPHORS•.7. BOLD AND EASILY READABLE.

4. TYPES OF COMMUNICATION MATERIAL:The commonly usable means of communication are:• Written: Trifolds, pamphlets, bulletins, leaflets and manuals.• Audio: Casettes, warnings, radio programmes.• Visual: Flip charts, puppetry, street theatre, cultural programmes of the area, TV.

4.1 Written Material:

Leaflet:• Printed information material of small and handy size.• It goes from hand to hand containing information on activities, services or events,

to be conveyed.• It is generally accompanied by other material.

Trifold: • A three fold leaflet which allows for printing of essential information in a concise

and attractive manner.• In preparing it, one should consider that the message be given through simple

images and short texts.

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• Its effectiveness or impact on the people will depend on the combination of colours, figures and text.

E.g. Sukh Dukh Mein Saath (Share Your Feelings).

Posters:• Low cost communication medium that is placed in selected places and can be seen

easily by the public. • It should be attractive, so that it can convey diverse themes in simple form.• It carries written contents, graphics or drawings. Its purpose is to keep the people

informed through selected notices. • We can place them in the schools, and individual houses in the community. E.g. Sankat Se Samadhaan (From Victims to Victors)

Banners:• Printed material of huge dimensions. It is put up from post to post.• It fulfills the function of presenting information.• It can be read from long distances. • It has a light background and contrasting letters.

4.2. Audio material:

Giving information verbally or play cassette through a loudspeaker. Loud speaker can be fixed in an ambulance, cart, van or other means of transport. Through this people can be informed of:• A danger or a pre-eminent disaster. • The normal reactions and steps to follow.• The institutions and organizations that offer help can be announced through out

the community.

!!!! Do not overuse it, prolonged use of loudspeaker can be disturbing!

Activity 5. On Radio BroadcastOne of the participants will take on the role of a broadcaster. The others will be listeners. They will have to keep their eyes closed in order to focus on what is being said. The ‘broadcaster’ will make an announcement regarding a danger situation. On opening their eyes the participants will be asked to recall the details of the announcement made.Do a discussion on clarity of message, retention of details, Efficacy of radio as a communication tool.

55

Preparing for a radio broadcast:

In a disaster situation, it is required that people are informed about disaster responses and told that these responses are normal. It is necessary to give information on what to do in a crisis situation because generally there is a great deal of confusion and chaos.

The community facilitator must be able to give out this information and prepare short messages to be broadcast through the local radio station.

E.g.A Radio Programme can be :This is All India Radio, Cuttack. Here is an important announcement.Fishermen on or along the coast are asked to immediately vacate ther coastal area.

Stormy weather with wind speed reaching 180km per hour is expected in a south south easterly direction, from the Bay of Bengal.(Warning pre-impact.)

This is All India Radio Cuttack. Here is an important announcement for people in the coastal area. • BE CALM! The people, who run about without control, crying or shouting create

panic and can cause severe accidents.• LOOK FOR A SAFE PLACE immediately. Save yourself before your belongings. • PROTECT THE CHILDREN and others in the community. (Post impact)

Preparing for a TV Interview

56

In a disaster situation, many journalists and TV reporters arrive at the disaster site and want information from the people in the community. It is important to understand that the information given by the particular person from the community is very important.

In such a situation the community facilitator or the representative of the community must be prepared to give out information that is:

• Accurate. Sticks to the facts of how many injured, extent of damage, number of people in need of medical and emotional assistance.

• Precise. The information should be such that listeners can easily understand the situation and respond to the needs expressed.

• Relevant: the problems or needs mentioned should be relevant to the situation of disaster. For example, the facilitator should avoid mentioning an event that had occurred prior to the disaster and is now not related to it.

Providing useful and accurate information about the event can ensure that proper relief and assistance is delivered to the community.

Activity 6:

On Communication

Duration: 90 minsDistribute pens, paper, chart papers, colour pencils, paint and brushes.

Make small groups:• Each group will decide on a psychosocial support related topic, which

will be promoted in the community. • Each group will choose one medium (audio or written) and type of

material (banners, leaflets, posters and handouts) they want to use.• The participants will prepare one material following the guidelines

provided.

Guidelines for discussion:• Is the material simple and easy to understand ?• Is it culturally appropriate ?• Is the information/content accurate ?

This module emphasizes the importance of promotion activities in psychosocial support and explains the basic elements of planning and preparing promotion strategies and materials. It aims to develop the community facilitator’s skills in preparing appropriate and simple material for psychosocial support promotion.

57

Module III emphasizes the elements of psychosocial support and care activities in the community. It attempts to equip the community facilitator with skills in planning and conducting stress management and self-care activities in the community.

FIELD VISIT TO ANY NEARBY COMMUNITY FOR Practical demonstration on Promotion of Disaster Mental Health: Sharing of Trifolds.

58

PRE/POST EVALUATIONName:____________________________________________Date: ______________

Institute/organization to which he/she belongs:____________________________

Place:_______________________________________________________________

Mark with a cross (X) shape against the correct answer:

Promotion of Psychosocial Support is:• Promoting mental health of the village.• Helping people to come together.• Educating people about the ways to reduce stress in disaster situations.• Making advertisements about disasters.• What is local committee ?• Group consisting of the political leaders in the village.• Group of teachers and doctors of the village.• Group of Red Cross field workers in the village.• Body of representatives of the different groups in the village that undertakes

psychosocial support related activities.

Messages in each phase should be:• Very lengthy and detailed.• Accurate, short and clear.• Very colourful and bright.• In beautiful and attractive writing.

In an organization:• Every body should have equal share of rights and responsibilities.• The leader should be able to take all the decisions.• There should be a hierarchy.• They should follow the same methods always.

In which phase of disaster are psychosocial support activities carried out?

• In the pre-impact phase.• In the phase of impact.• In the post-impact phase.• In all the above phases.

Post TestAnnex 3.1

Module 3: Promotion of Psychosocial

Support

59

Guidelines for Preparation of Material

The material should answer the following questions:• Who ?• When ?• Where ?• How ?• How Many ?• What ?

For Example,

A Psychological First Aid course will be given in Ratnal. Volunteers of IFRC will offer the course. The Course will take place on 17th march 2003. All persons interested may register with the local Red Cross Branch. The course will be 16 hours long and will provide a certificate of completion.

For example,

FACE CRISIS TOGETHER: A PLAY ON PARTICIPATION

COME WATCH A STREET PLAY BY THE CHILDREN OF PRIMARY SCHOOL, ADESAR GAON.

VENUE: Primary School Playground.

TIME: 2 PM

DATE: 25th JULY 2004.

COME ONE COME ALL!!

Annex 3.2

60

• Functions of the Local Committee:

BEFORE THE EMERGENCY

• Organise training on topics like what is psychosocial support, how to assist people in emotional distress after a disaster, for volunteers in the community.

• Create a Local Emergency Plan and a community map. • Guide and supervise the work. • Make a list of the human, material and economic resources the community has. • Make a list of the resources the community does not have. • Work with other social organisations, such as the aanganwadi, the PHC or sub centre, the

Panchayat. • Identify the safe zones in your community.• Identify the danger points in the community. • Organise a team to identify the damages and find out needs of the community. • Organise activities such as prayer meetings, community feast to strengthen unity among the

community.

DURING THE EMERGENCY

• Set up a centre to carry out emergency operations such as rescue, treating injured, contacting relief organisations.

• Help people to safe places or shelters, search for missing persons. • Establish communication system to keep the community informed, take responsibility to talk

to media persons. • Transport the people using the means of transport available in the community. • Help the affected people to reach trained personnel or assistants (medical or first aid attention

and supply of medicines) for assistance.• Set up a team to identify the damages.

AFTER THE EMERGENCY

• Prepare a report of the damages, losses in the community. • Initiate the rehabilitation activities. For example, re-building houses and buildings

according to the needs of the people. • Organise the community to express their needs and concerns. • Make a vulnerability map to know the number of people with special needs and transfer

them to a PHC or sub centre or doctor. • Encourage the affected population to take part in the rehabilitation and reconstruction

work.• Search help for the reconstruction program.

Annex 3.3

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SESSION GUIDELINES TO MODULE III

CONTENTS ACTIVITY SOURCES DURATIONRecap of the previous session. Introduction to Module – III

Discussion

Presentation of module

10 mins

10 mins

PRE TEST Annex 3.1 20 mins

1. Promotion of psychosocial support in disasters.

1.1. What is Promotion of psychosocial support?

1.2. What is promotion of psychosocial support.

1.3 psychosocial support program includes.

Lecture

Brainstorm

Lecture demonstration

Activity 1Group exerciseGroup exercise on information, education and communication.

30 mins

30 mins

20 mins

2. How can we promote psychosocial support 2.1. What is an organization?

2.2.What are social networks?2.3.Local committee of psychosocial

support

Lecture demonstration

Brainstorm

Role play/Lecture demonstration

Activity2- BrokenSquare

Activity 3- Role play

15 mins

10 mins

20 mins

30 mins

3. Guidelines for promotion.3.1 What is a target population?3.2 How to identify the main theme?3.3 What will we use., 1.1. Type of messages in each phase.1.2. Preparation of messages.

Lecture demonstration/

Brainstorm

Activity 4 45 mins

4. Types of communication material4.1. Written materials. 4.2. Audio materials

Lecture demonstration.Group work

Activity 5 (Refer Annex 3.2)Activity 6

10 mins 90mins

Field Visit to any nearby Community

Practical demonstration on Trifolds Sharing

2 hours

POST TEST Annex 3.1. 20 Minutes

Total Hours 8 hours

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Objective:Develop information of preventive psychosocial support activities in the community.

Expected Outcome:The Community Facilitator will be able to:• Explain three components of bringing the community together (community

organisation) in a disaster situation and implement at least one in the community.

• Organise and form support groups for people at-risk or affected by disasters.• Plan and carry out psychosocial support activities in the community through the

local committee.

4Community

Based Preventive

Psychosocial Support

Activities

63

The objectives of the module are:• Describe methods for bringing the community together before, during and after a

disaster.• Describe what are support groups and how to organise them.• Describe the importance of unity and work together and how it can be encouraged

in psychosocial support work.• Describe what are psychosocial care activities.

PRE TEST (Annex No. 4.1)

1. T%ools for bringing the community together (Community Organisation) before, during and after a disaster

What is community organization ?Community organization mean to bringing together different groups in the community who can carry out activities which will help the community respond to disasters in a better way:

The methods for community organization are:• Organizing support groups. • Developing of pro-social behaviours.• Encouraging unity and working together.

BRAINSTORM on community organization.

Guidelines for discussion:a) What are the factors that make people participate ?b) Do you participate in community activities ?c) What makes you participate ? d) What do you understand by community organization ? e) What do you think can help in making different groups work together for

psychosocial support?

1.1. Organizing Support Groups:

What are support groups ?• Support groups are groups of people who share and exchange their feelings,

Introducation

64

thoughts, emotions and help each other deal with them.• Support groups help survivors recover from the emotional pain caused by disaster

by talking about similar experiences.

Support groups have the following objectives:• Talk about personal experiences related with the disaster/event that help express

sentiments, emotions and thought.• Share similar experiences with other members. For example, loss of family

member. • Find ways of solving problems by talking and sharing personal feelings and

emotions.

For whom ?• People who have experienced a disaster. Vulnerable groups such as:• Elderly• Women • Children • Adolescents

How to organise support groups ?• Form groups of 5-10 members.• The scheduled time for each session should be one hour. • Request the participants to talk about experiences of the event. What did they feel

? What was their life like before the disaster ? How has it changed ?• Recognise expressions of sadness, anguish, fear. Allow members to share it freely

without interrupting.• Help recognise emotions through conversation between members.• Use drawings, theatre, song and dance, prayer and community metaphors to help

members express feelings.• Clarify misconceptions about the cause of disaster.• Emphasize the importance of pro-social behaviour,group unity and togetherness to

recover from the grief and sense of loss caused by disaster.

Work with children:• Ask them to paint scenes of the disaster. Help them express feelings through

drawings.• Make children understand disasters better so that they are able to deal with the

fear. • Use drama, music, toys, story telling as methods.• Organize cricket matches, picnics and outings to remove children from the disaster

site for a few hours.

VISUAL WHICH DEPICTS ACTIVITY WITH CHILDREN

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Work with adolescents:• Motivate them to volunteer in community activities. For example, taking care

of the younger children, setting up youth clubs against alcohol and substance abuse.

• Organise sports activities such as cricket matches where they can participate.• Motivate them to attend school.• Help them to communicate with family and friends.• Give them information about the bad effects of drugs, alcohol and tobacco.

VISUALWHICH DEPICTS ACTIVITY WITH ADOLESCENTS

Work with elderly :• Help to express experience of loss, past and loved ones.• Direct to available resources such as pension benefits, relief.• Reunite with family members, neighbours and friends.

VISUALWHICH DEPICTS THE ACTIVITY WITH ELDERLY EELDERLY

[Refer to handbook module IV Q.No. 1 ( A&B.)]

2.2 Developing pro-social behaviour :

What is pro-social behaviour ?Pro-social behaviour is:• Act, which benefit others in our community.• Is positively valued by members of the community.

Encouraging pro-social behaviour is very important because it helps a community to work better together. It reduces the number of conflicts and misunderstandings when people are doing things for the benefit of others in the community.

For example, when members in the community become highly motivated to contribute positively to their community after a disaster, they will take part in relief work, assisting the homeless and orphans, cleaning the damaged property.

Activity 1:

On pro-social behaviourProcedure: Gather the participants. One of the participants suddenly turns dizzy and falls (as per instructions of the promoter given before.) Some of the other participants react some stand and stare. Others come forward to help. The latter is pro-social behavour.

BRAINSTORM.

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The decision process in pro-social behaviour (Latane and Darley, 1970):

Pro-social behaviours encourage participation of members in a group or community because people want to be helpful towards each other. They want to be of service to the community.

1.3 Unity and work together (Solidarity and Col-laboration)

Why do we need unity in psychosocial support work ?• Unity among members helps the entire community to focus on one problem, which

is most important to all of them. • Unity among family members, neighbours and other groups in the community will

make them respond to a disaster situation together. • Unity can help the community to recover faster from the damages and losses

suffered from a disaster.

Attend to what is

happening

Define event as

emergency

Assume responsibility

Decide what can be done

Give help

67

• A feeling of oneness makes people feel like they belong to a group and have a common goal. In each selected community, members will make goals that they want to achieve. The achievement is going to depend on the effort and the support of each member.

• It goes beyond understanding situations, and shows through work done together. It implies a change of attitude where people understand each other by placing themselves in another’s place. Unity or solidarity means an absence of a superior, patronising attitude.

How to encourage unity (Solidarity) ?• Building a sense of self: By encouraging an atmosphere of warmth and friendliness

and not competition. People should be willing to help each other. • Respect for every individual: One should have respect for other human beings

above all differences. For this one should.• Talk with each other and discuss matters freely. • Respect every person as a human being who has an idea, opinions, feelings

just like yourself.

• Effective participation: It is to share and assume responsibility for any activity that is undertaken for the community’s benefit. It is important to work together with all the groups in the community.

• We should consider the following:• To share things, works, feelings and problems.• To realize and value the virtue of sharing and helping each other.

(Refer to handbook module IV Q.No.2)

To compromise oneself for change in favor of the group:

One Should have the feeling of ‘we’ that will benefit the entire community.

This means• Value the importance of working together for the benefit of the entire

community.

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• Keeping the ultimate goal of serving your community in focus.

Working together (collaboration) involves:

• Agreement between members – wherein the group is able to resolve conflict and differences between members and set common objectives that each member feels responsible for.

• Networking – This helps in reaching desired goals faster because all the organisations in the community work together on similar work, share and exchange information and resources.

• Ability to respond to situations: Groups working together must be prepared that what they want to do may not be done easily because of the situation. They must be prepared to be dissapointed and frustrated, yet be willing to continue working.

• Talking – This is very important when members from different groups work together. Members may have different ideas about the same problem. The best way to avoid conflicts in such a situation is for every member to share what he/she thinks on the subject.

Activity 2:

ENERGISER (Tie and Untie a Knot)

Duration: 15 min.

Procedure: Participants are made to stand in a circle, holding hands.One participant lets go up one hand bends down and starts weaving in and out up the joined hands. This creates a tangled knot. That same person is made to retrace his/her steps to untie the knot. This demonstrates how a solution can be found in the removal of a problem.

(Refer to handbook module IV Q.No. 3)

69

2. STRESS MANAGEMENT AND SELF-CARE TECHNIQUES.What is stress management ? • Both survivors and people who are helping survivors in a disaster site can face the

same kind of stress. Rescue workers see so many people who have lost their homes, their near and dear ones, their source of living, have suffered physical injuries, while working in the field. This has an effect on their health and emotional well-being also.

• Stress management includes activities, which will help both survivors and rescue workers to reduce emotional distress and stress caused by the disaster event.

We can reduce stress by following some practices such as :(Saakvitne, Pearlman, 1996)

Build your energy levels:• Eat all three meals.

• Take rest

• Get enough sleep.

Keep your emotional reserves:• Seek emotional support (from family and friends). Talk to them about your

feelings.

• Don’t blame yourself for what happened. Set goals for the future which you can achieve.

• Prepare yourself for frustrating moments when you are nor able to achieve what you want.

• Think positive thoughts about yourself, praise yourself.

• Allow yourself to cry.

• Find things to make you laugh.

Psychological Self-care • Share with others what you feel, what you like and do not like. This will help

others to know you better.

• Do something at which you are an expert or in charge. This will make you feel better about what you can do.

• Engage in activities, which you enjoy. For example, take part in community activities, go to the cinema, spend time with the family, take part in song and dance activities.

70

Spiritual Self-care• Meditate.• Pray• Participate in community prayer meetings.

(Refer to handbook module IV Q.No. 5)

BRAINSTORM

Guidelines for discussion:a) Have you ever faced stress in your daily lives ?b) How do you deal with it ?c) What do you do when it continues for a long time ?d) Would some of you like to share your experience with the whole group ?

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2.1 Deep Breathing

A proper breathing technique can be a cure for stress, which very few of us practice. Taking deep breaths and regularised breathing patterns can relieve tension and stress and make us feel calm and relaxed.

2.2 RelaxationRelaxation exercises help to reduce the tension in our muscles. They help to loosen our body and get rid of any aches or pains.

It is used: when there is muscular tension, anxiety, difficulty in sleeping, head and stomachaches, hypertension, fear.

Time: - Relaxation and deep breathing exercises for 15 minutes every day can relieve stress considerably.

Method: One can practice relaxation sitting on a chair with your head rested. Each muscle or group of muscles is tensed for five or seven seconds and then relaxed for twenty or thirty. One should repeat the process at least once. If after this there is some area that remains tensed, one can repeat everything five times.

72

Activity 6:

EXERCISE on deep breathing and relaxationDuration: 90 minsRefer Annex 4.1 and 4.2.

Visual Calamity (reaction) – hopeful future (reaction)

2.3 Visualizations and affirmations:Visualization is the ability to imagine and see what you want to achieve. When we are going through a difficult situation, our ability to see ourselves in a better situation helps us to take steps to improve that situation. Visualization is

DESIRE + BELIEF = POWER

Desire to achieve, ability to believe in oneself and change motivates us to action.• It is not enough to dream about change.• We must BELIEVE in the change.• It is not enough to believe.• We must ACT.

Affirmations are short phrases that express a positive aspect about you. They are meant to give you confidence and make you feel worthwhile.For example,

“I AM A GENEROUS HUMAN BEING.”

(Refer to handbook module IV Q.No. 6)

Activity 7:

EXERCISE on affirmation.Duration: 30 minsProcedure:

• Each participant will stand up and say one quality about him/her self loudly and assertively.

• Then the entire group stands up and chants one affirmation about the group three times.

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This module explains the specific activities that a community facilitator can undertake to assist a survivor affected by disaster. It also teaches self-care techniques to the facilitator by which he/she can take care of his/her own emotional needs when working in a stressful disaster site.

The Community facilitator is introduced to topics such as psychological first aid and given skills such as visualizations and affirmations to maintain his/her motivation on the field.

74

PRE/POST EVALUATIONName:____________________________________________Date: ______________

Institute/organization to which he/she belongs:____________________________

Place:_______________________________________________________________

Mark with a cross(X) shape against the correct answer:

What is pro-social behaviour ?• Behaviour that’s pleasing to everybody.• Meeting people in the village daily.• Having an attitude that benefits all in the village and is positively valued by

all.• Carefree towards life and everybody in the village.

What is a support group ?• The social working agencies that come at the time of disasters.• Red cross volunteers and field workers.• The donors that give money for reconstruction.• The fellow village people.

Crisis intervention is:• Helping a mentally disabled person.• Helping at the time of disasters.• Restoring one’s capacity to face the results of a crisis situation • Giving advice.

These are techniques of self-care:• Promotion and prevention.• Animation and presentation.• Relaxation, deep breathing, visualisation and affirmation.• Dynamic groups.

Post TestAnnex 4.1

Module 4: Community

based preventive

psychosocial support

activities

75

OBJECTIVE: The participants should know and understand techniques of stress management and self-care to work with groups of people that live exposed to risk and/or are affected by disaster.

DURATION: 45 minutes

MATERIAL FOR USE: carpets or durries

METHODOLOGY:

1. Deep Breathing:

a. Although one can practice this exercise in different positions, it is best in a comfortable and relaxed position, on the floor or on a carpet. Fold your knees and keep your legs about 20 cms apart. Make sure that the spine is straight.

b. Breathe air slowly and deeply. Try to identify the areas in your body where there is tension.

c. When one is relaxed, inhale air a little through the nose and exhale through the mouth. Make a soothing sound which makes you feel relaxed. Take deep, small and long breaths that elevates and deflates the stomach. Concentrate on the sound and the sensation that is produced by the vibration.

d. Continue with 5 or 10 minutes of deep relaxation one or two times a day for a few weeks, then, if it is desired one can prolong it for 20 minutes.

e. At the end of each session of breathing give a little bit of time to explore once more your body in search of signs of tension. Compare the tension that you feel at the end of the exercise with what it was at the beginning of the exercise.

f. Once you are familiar with this style of respiration practice it daily.

g. Concentrate on the ascending and descending of the abdomen, on the air that goes out of the lungs and the feeling of relaxation.

2. Relaxation Duration: 45 minutes

a. This exercise can be practised in two positions, sitting on the floor on a blanket or a cushion.

b. Modulate your voice.

Annex 4.2

76

3. EXERCISES:

1) Close your eyes. Be comfortably seated so that all the parts of your body are comfortably supported by the chair.

2) Relax yourself. Take deep breaths. Relax all your muscles.

3) Slowly focus your attention on your arms and release every tension

4) Concentrate on the muscles of your arms, your biceps, your forearms and your hand.

5) Feel relaxed.

6) Now concentrate on the face muscles. Feel relaxed and free.

7) If your attention diverts, concentrate on the muscles till you feel numbed and relaxed.

8) The relaxation now extends to the buttocks, legs and your feet. You can feel them, concentrate on those muscles.

9) Now all the muscles of the body are relaxed, completely relaxed.

10) There is no tension in your body. Feel a sensation of weight on all the muscles and a gentle heat.

11) Let this sensation enter your body. It’s the feeling in which all the muscles are more and more relaxed. Let yourself go in a more deep state of relaxation. All the parts of the body are very relaxed, very calm and very light. Don’t do anything, let yourself go up. Let the respiration be rhythmic, monotonous and calm. Feel the state of well-being and calmness that it produces in you.

12) Now imagine different places, maybe a beach or the hills. Choose a place where you like to relax and you will enjoy alone. Imagine the smells, sounds, feeling of being in that place. How are you feeling? Enjoying! Imagine doing what makes you more relax. Feel the tension going out of the body. Feel relaxeded. calm and at peace.

13) Now… when you are ready…you can allow yourself to concentrate on what surrounds you. Slowly, open your eyes. Feel that you have found warmth and comfort. Now breathe deeply three times. Stretch your arms.

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SESSION GUIDELINES TO MODULE IV

CONTENTS ACTIVITY SOURCES DURATION

Recap of the previous day’s session.Introduction

Brainstorm

Presentation of module IV

20 mins

10 mins

PRE TEST Annex 4.1 20 mins

1. Methods for bringing the community together (community organisation)1.1. Organising support

groups1.2. Encouraging pro-

social behaviour1.3. Unity and working

together

Brainstorm

Lecture demonstration

Lecture demonstration

Lecture demonstrationEnergiser

Activity 1

Activity 2

30 mins

30 mins

15 mins

15 mins

15 mins

1 Stress management and self-care techniques. 1.2 Deep Breathing1.3 Relaxation. 1.4 Visualisation and

affirmation

Brainstorm

Lecture demonstration/ Exercise

Activity 6

Activity 7

60mins

90 mins

15 mins30 mins

POST TEST Annex 4.1 20 mins

Closing Course evaluation Annex 4.3 20 mins

TOTAL HOURS 6 hours 20 minutes

78

Objectives:1. Understand the significance of Psychological First Aid.2. Explain the importance of stress. 3. Learn basic skills to deliver Psychological First Aid.

Expected outcome: By the end of the session the participants will be able to:1. Recognize at least five principles of Psychological First Aid.2. Identify at least two kinds of stress reactions.3. Deliver the five steps of Psychological First Aid.

5Psychological

First Aid

79

The purpose of the Psychological First Aid module is to give Red Cross Volunteers and Community Based First Responders certain familiarity about how to deliver psychological first aid to survivors of a disaster or a daily life crisis ?

Pre-Test Annex 5.1

Activity 1:

Remembering events of past The participants will be asked to write about a sad event of their

past. The participants will be asked to write about the first time they brushed

their teeth or wore their clothes themselves.

Inference:• You remember the sad events.• You do not remember the insignificant events.

80

To offer a cure, one must know the ailment. Psychological First Aid is a common cure for people in distress. But first one must understand what kind of distress it is. Then the relevance of the psychological first aid can be understood.

Psychological first aid is as important as physical first aid. When someone is bleeding, you don’t immediately take the person to the Emergency room; you do something to stop the bleeding, and then take him/her to the Emergency Room. Likewise, you do not offer a person in need of immediate psychological assistance, trauma counseling, or take them for psychotherapy. Firstly because in India, there are very few psychiatrists and psychologists to assist such a vast population and secondly, not all psychological problems require professional intervention. There are simple ways of assisting people in distress, which the fellow human beings can offer. These simple ways constitute Psychological First Aid.

1. Relevance of Psychological First Aid for a disaster, emergency, and or crisis.Almost every person faces difficult times in life. But some people face problems of greater magnitude and severity like disasters/ crises.

1.1 What is a disaster ?A disaster is a serious disruption of the functioning of a society, causing widespread human, material, or environment losses, which exceed the ability of the affected society to cope with, using only its own resources. Disasters are often classified according to the speed of onset (sudden or slow), or according to their cause (natural or man- made).

An overview of Disaster Management, 2nd Edition, (1992), UNDP, Disaster Management Training Program, Wisconsin Disaster Management Center.

Disaster is an event that exceeds the community’s capacity to respond. Disaster can be classified as • Natural disasters such as cyclone, earthquake and drought. • Man-made disasters such as communal riots, industrial accidents and fire.

A Disaster affects us in many ways:

We may lose the social structure such as family, neighbours, and other groups. The size and the range of the disaster will determine the disruption in the workplace,

Introduction

81

schools, and local infrastructure such as light, water, and communications. There are some preconditions which will impact the magnitude of the disasters. These are poverty, unemployment, lack of information, and not having a support network. During this period the community has some specific needs sometimes referred to as basic needs, which include water, food and shelter. A disaster is classified depending on the speed and the cause.

1.2 What is an emergency ?An emergency is an unforeseen event that is marked by a clear deterioration in the coping abilities of a group or community. Emergencies are reflections of normal life. For example a person knows that the brake shoe of the car is worn out. The person has earned his/her weekly salary. A decision has to be made on whether to fix the brakes or buy food, so the person buys food. As a result of this decision he/she loses the brakes while driving and has an accident. An emergency has three components (1) an underlying cause (poverty), (2) dynamic pressures (how to spend money), and an unsafe condition (car is unsafe to drive).

1.3 What is a crisis ?It is an event that exceeds the capacity of an individual to respond.

A crisis is an event that precipitates social readjustment. A crisis is an event caused by traumatic stimuli such as loss of life, injury, sudden illness, change in environment, winning a lottery, or simply a promotion at work. How a person faces the crisis, whether it is perceived as a problem or as an opportunity, results in the behavioral reaction.

2. Psychological first aid.Psychological first aid is a first order response, of short duration, to a person who is experiencing distress as a result of a disaster, an emergency or a crisis. The SPHERE 2004 manual defines psychological first aid saying it“entails basic non-intrusive, pragmatic care with a focus on listening, but not forcing to talk; assessing needs and ensuring that basic needs are met, encouraging but not forcing company from significant others; and protecting from further harm”.

(Sphere document, 2004. Pages 293.)

Based on the SPHERE standards psychological first aid proposes five steps. (1) Provide for basic needs, (2) listen to the survivors’ distress, (3) accept the feelings and understanding that these are normal reactions to abnormal situations, (4) assist with next steps by reuniting with loved ones or providing timely and accurate information, and (5) refer to appropriate support systems (for medical needs to the

82

health post, for spiritual needs to the appropriate spiritual guide, for a lone person to a support network).

Figure 1: Illustrations below show an example of a crisis and the necessity of emotional support beyond physical first aid.

Though physically fit, victim needs psychological healingThe illustration depicts how the physical wound gets healed after physical first aid is given but the fear for motorcycle persists. Thus, emphasizing some kind of additional assistance in a situation of disaster/ crisis is needed i.e. 3.Psychological First Aid.

Psychological First Aid is a brief, first order intervention for a person facing a disaster or a crisis in order to prevent persistence of deeper psychological impact.

3.1 What are the conditions that will cause a reaction of distress ?The following conditions during the disaster, emergency or crisis will serve as an indication for psychological first aid.1. Physical proximity to the disaster.

Motorcycle accident needing physical first aid.

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2. Emotional proximity to an event.3. Whether or not there are secondary events such as a disruption of daily routines

through the loss of shelter, work place, or transportation. 4. Whether or not a disaster has occurred by natural causes, such as hurricane or

flood, or is caused by an act of another person known or unknown. “God’s Will” is more readily accepted than accidental or premeditated harm caused by another human being.

3.2 Individual Factors:Many individual factors can affect the way a person responds to a disaster. These include genetic vulnerabilities and capacities, prior history of constant stress or exposure to past disasters, history or presence of a psychiatric disorder, having lower education and income, lower IQ, being divorced or widowed, health issues or psychopathology within the family, the presence or absence of family and social support structures, the age and developmental level of the individual. Children represent a particularly vulnerable population.

When a disaster, an emergency or a crisis occurs, the survivors depending on the level of exposure will require emotional support along with other relief material. By alleviating stress,psychological first aid will help the survivors to sustain mental/physical performance during routine activities, under extremely adverse conditions and in hostile environments.

Three main things need to be done when caring for these survivors. 1. Provide information about normal behavioral responses to a disaster. Most people

want to know they are not abnormal. 2. Provide for the survivor’s basic needs. Some survivors will have no access to money,

food or shelter.3. Refer the acute distress reactions to mental health professionals.

The Concept of distress and stress• Define stress.• Explain two kinds of stress reactions.• Understand how stress affects individuals.

4. IntroductionThere are many definitions of psychological distress; most of them include some type of overwhelming, unanticipated danger from which one cannot escape and for which there appears to be no method of either decreasing the danger or the individual’s anxiety.

The disaster survivor may almost instantaneously develop distress symptoms including a feeling that one’s heart is about to burst, difficulty in breathing (so

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that one feels smothered), trembling, muscular tension, perspiration, nausea, mild diarrhoea, and anxiety.

These responses are complex and include biological defenses against the threat, the activation of mechanisms related to past learning and adaptation in similar situations, response to social cues (i.e. behavior is shaped by the behavior of those around us – running or going into a building as a result of a loud noise), reactions to immediate loss or separation from a loved one and the effects of the cognitive disarray that can occur from experiencing chaos all around. Hysterical reactions are uncommon during a disaster or a crisis.

4.1 Factors that can affect a person’s response to a disaster, an emergency or a crisis.There are a number of factors that increase the distress of people experiencing a disaster. They include:

1. Being a direct victim as opposed to a witness (e.g. seeing it live on television). 2. Having a daily routine disrupted (e.g. loss of shelter).3. Whether the disaster is natural or manmade. 4 Socio-economic status (poverty, caste, religion, gender).5. Support systems (family and friends). 6. Level of emotional developmental (e.g. Children often respond to disasters just

like their parents do).

Illustrations to show how stress affects individuals with help of rock example:

With a small rock the bridge with a little bigger rock, the is intact Bridge develops cracks

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With a even bigger rock, the bridge collapses

The effect of stressful life events on a person:

Small events, adult copes Bigger events, adult has difficulty in coping develops symptoms of stress

Still bigger events, adult unable to cope and breaks down

Lost pen

Copes

Lost job

Difficulty in coping

Disaster/crisiseg. Death of loved

ones

Can’t Cope

Pick Pocketed

Missed bus IrritationHeadache

Worries

Difficulty in sleeping

Break down

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4.2 What is stress ?Stress is the body’s response to situations that pose demands, constraints or opportunities. (Bryce C.P., 2001)

In day-to-day life any one can experience stress but it depends on person to person how stressed s/he feels in one situation. For example, a boy who has to take his exams might either feel extremely stressed and fall ill or he might feel moderately stressed and concentrate on studies. Stress is not always negative. Some amount of stress is required to give optimum performance. It is the chronic stress that can have a negative impact on a person.

Stress reactions are divided into four categories i.e. physical, emotional, cognitive and behavioral. Though the most common stress reactions are simply inefficient performances, such as:

• Slow thinking (or reaction time). • Difficulty sorting out the important tasks from extraneous activities and seeing

what needs to be done. • Difficulty getting started. • Indecisiveness, trouble focusing attention.

Activity 2:

Exercise on stress (Refer to Example -1)Brainstorm Guidelines for discussion:

• Have you witnessed a disaster?• What were your reactions to the disaster?• What were the behaviour of other survivors?

The facilitator will write all the reaction and behaviour on the flip chart.

Physical reactions:• Fatigue, exhaustion• Appetite change• Tightening in throat, chest or stomach• Worsening of chronic conditions (high blood pressure, asthma, diabetes, or

heart condition).• Somatic complaints

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Behavioral reactions:• Sleep problems• Crying easily• Avoiding reminders• Excessive activity level• Increased conflicts with family• Hyper vigilance, startling reactions• Isolation or social withdrawal

Disaster Mental Health Response Handbook (July 2000). Center for Mental Health, North Sydney, NSW Although the behaviour described above usually diminish with time, some do not.

A person, who has not improved somewhat within a day, even though he or she has been given warm food, time for sleep, and opportunity to ventilate, or who becomes worse, deserves specialized medical/psychiatric care. Do not wait to see if what he is experiencing will get better with time.

Factors involved in Stress Tolerance:There are three factors involved in tolerance of stress. They are:

• The environment (the stressor).• The way the person perceives the environment.• The way a person judges his/her emotional resources.

As shown in the bridge and stone picture the capacity of the bridge depends on the load that is put on it, the material with which it is built and the engineering design with which it is built to take the load. Similarly in an individual the tolerance to stress depends on the emotional load of the event, the perception of the event by the individual and the use of the emotional resources by the individual to cope with the stress.

Example1. Take an ordinary rubber band. Stretch it from both the sides. It stretches up to a point and then it breaks. This breaking point is when the stretching power of the rubber band gives way. This demonstrates that a person can cope up to a point but not beyond.

Importance of Non-verbal Communication

• Highlight importance of Nonverbal Communication.• Emphasize the need of use of correct nonverbal communication in Psychological

Nonverbal communication is a mode of expression exclusive of verbal communication.

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Activity 3:

A participant is asked to hide behind any large object or cover himself. He/she is then instructed without others knowledge to relate a sad story with verbal modulations

Participants are asked to give their thoughts on the verbal message.

Activity 4:

The same participant is then asked to express sadness without using wordsThe participants are asked about their observation.

Inference:• Feelings can be conveyed non –verbally.• Non-verbal communication can be as powerful as verbal communication.

Non-verbal communication is to a great extent spontaneous and without conscious awareness

Activity-5:

Participants are asked to show specific emotions (such as happiness, sadness)

This is conveyed to them by written instructions.After the participants complete they are asked about the particular nonverbal communications they used during the presentation.

Inference: • Non-verbal communication is often spontaneous.• Discloses feelings without conscious awareness.

Non- verbal communication has various key components. They are as mentioned below: 1. Eye contact: It is important that while communicating with a person, there

should be a direct eye contact and one should be focused on what the person is sharing. If a survivor is sharing his story the emotional assistant should not look around because looking into the eyes of the survivors would help in building the rapport.

2. Body posture: Body postures express the person’s internal feelings. For example, if

a person is sitting straight that signifies that he/she is alert. Emotional assistant

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should sit in front with survivor with his/her palms open, which portrays that the emotional assistant is not having closed feelings.

3. Distance/ Physical contact: Physical contact will denote confidentiality and trust.

Emotional assistant should sit close to the survivor, if it is culturally appropriate. For example if two people are sitting close to each other, it signifies closeness between them.

4. Facial expressions: Facial expression gives a lot of information on how a person

is feeling. For example, happiness, sadness, fear or anger is reflected by facial expressions.

5. Gestures: Gestures also indicate the thoughts of a person. For example, nodding

head in affirmation shows that the person is interested in the talk. When listening to a survivor’s distress, it is advisable to hold the survivor’s hand or touch his/her shoulder, if culturally appropriate.

6. Vocal tone, volume: The tone of the voice reflects the feelings of the person. For

example, if a person is saying something nice but the tone is rude that signifies that internally the person is feeling different from what he/she is saying verbally.

Some illustrative examples are given below:

1. Anxiety:

• Trembling of hands. • Constantly changing body posture.• Acute voice.• Clearing throat.• Vague look.

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2. Lack of interest:

• Vague look • Looking around.• Monotone voice.• Moving the feet.• Yawning

3. Confidentiality:

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• Looking to all sides.• Eyes half shut.• Mouth is covered.• Low voice.• Mumbling.

4. Not caring: • Hands on the waist.• Extended legs.• Looking the other way.

5. Irritated:

• Red face.• High tone of voice.• Pointing with finger.• Cold stare• Forehead wrinkled.

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A listener should follow the below mentioned guidelines to be an effective listener:

1. Sit in front of the individual with open hands.

2. Do not fold arms.3. Maintain direct visual contact.4. Interpret the total message (words,

body language, facial expressions)5. Encourage the speaker to express all

their feelings without repressing.6. Pay attention. Looking at a person

and moving head freely confirms that you are willing to establish contact and are paying attention.

7. Listen carefully and retain information received to be able to use it in the future.

8. Do not speak out your ideas. Be careful with what you say.

Activity 6:

Open palm Listening Procedure:

• Divide the participants into pairs• They can occupy any part of the room or area they feel comfortable• They can sit on a chair or on the floor wherever they feel comfortable• Give them five minutes to share an event with the other• Mention that the listener will keep his/her palm facing upward and body

leaning forward• Facilitator can demonstrate the Open Palm technique

Guidelines for discussion: • How did you feel ?• Did the persons posture make you feel less or more comfortable?• Did you feel that the person was really listening to you? If yes, why ?

If not, why not ?

Implementation of Psychological First Aid

• Learn basic skills to deliver Psychological First Aid.

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Brainstorm Guidelines for discussion:

• When an individual is in crisis what do you do to make him feel better ?

First aid can be applied to stress reactions of the mind as well as to physical injuries of the body. You must know how to give psychological first aid to be able to, help yourself, your friends and family, and the community in times of a disaster or of a personal crisis.

Psychological first aid measures are simple and easy to understand. Improvisation is in order, just as it is in splinting a fracture. Your decision of what to do depends upon your ability to observe the survivor and understand his/her needs. Time is on your side, and so are the emotional resources of the survivor you are helping. Making the best use of resources requires ingenuity.

If psychological first aid is offered early to survivors during the immediate response period, the survivors stand a good chance of recovering early and of becoming an effective member of the community recovery efforts.

Psychological First Aid is the holistic first order intervention that can be delivered in five simple steps, which are:

1. Meet the immediate needs2. Listen, listen, listen3. Accept the feelings expressed by the survivor4. Assist with next steps5. Refer and follow-up

Step I. Meeting the immediate needs:• Take the survivor to a safe place protected from further threat• Provide physical first aid, if needed• Offer something to drink or eat• Make the survivor feel comfortable• Protect people who are upset or agitated from harming themselves and others.

Step II. Listen, listen, and listen:• Share the reality of the person• Actively participate in the conversation by looking into survivor’s eyes and

repeating the key words to facilitate the survivor’s expression.• Gently touch the survivor’s hand or shoulder, if appropriate• Take time to listen when people describe what happened. Telling their story will

help people understand and eventually, accept the event

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Step III. Accept the feelings expressed by the survivor:

• Empathize and validate feelings expressed by the survivor• Normal responses to disaster include feelings of anxiety, grief, guilt and anger.• Listen non-judgmentally without interrupting or being critical• Do not give advice or false assurances. For example, “I understand how you feel”.

Step IV. Assist with next steps:• Provide factual information about where and how they can seek specific resources• Encourage survivor to plan a personal action plan for the immediate situation• Follow-up by visiting and helping out if the survivor is not able to manage• Let the survivor evaluate and progress and feel some sense of mastery

Step V. Refer and follow-up:• Identify survivors who need further counseling or intervention• Refer survivors who do not respond to your intervention • Link them to systems of support.• If needed, follow up the next day.

Activity 7

• Two balloons are inflated and kept on the floor.• Two participants are asked to walk around trying to stamp the balloons.

(Secretly instructed not to burst the balloons)• Two more participants are asked to protect the balloons and keep it safe for

future use. • Others are to observe the activity and reflect on it.

Expected outcome:

• Emphasize the steps of Psychological First Aid in the context of the balloon. (See illustrations below)

Illustrations below show simple ways of remembering the steps:

Balloon needs to be provided immediate Balloon needs to be deflated so that protection and care from danger possibility of bursting is decreased

Step 1. immediate Needs

Remove from site of danger

Step 2. ListenStep 3. Accept Feelings

Deflated

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Plan to keep the balloon at a safe place If there are holes in the balloon, it needs to so that it has a secure future be repaired

Guidelines for accepting the feelings of the survivor:

• Accept the survivors you are trying to help without censorship or ridicule.

• Accept the survivors’ right to their own feelings. Even though your feelings, beliefs, and behavior are different.

• Do not blame or make light of the way the survivor feels or acts. Your purpose is to help the survivor in this tough situation, not to be critical.

• A survivor does not want to be upset and worried; the survivors would "snap out of it" if they could.

• When a survivor seeks help, he or she needs and expects consideration of their fears, not abrupt dismissal or accusations.

• Realize that people are the products of a wide variety of factors. All persons may react in different ways to the same situations. Each individual has complex needs and motivations, both conscious and unconscious that are uniquely his/her own.

• Often, the "straw that breaks the camel's back" the one thing that finally causes the person to be overloaded by the stressful situation is not the stressor itself, but some other problem. Thus, an injury or an emotional catastrophe will have a personal meaning for each individual.

• Even though you may not share the reactions or feelings of another person, and even though the reactions seem foolish or peculiar, you must realize that the person feels as he does, for a reason.

• You can help the person most by accepting the person, and by doing what you can for the survivor during this difficult time.

• Understand that the survivor is doing the best he can under the circumstances.

Your positive assistance and trust may be what the survivor needs, to do better.

Step 4. Plan & Follow up

Safe storing place

Step 5. Referral (if necessary)

Repair

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Who require Psychological First Aid ?Any person who is in a crisis requires Psychological First Aid. During a disaster it is not just the survivors who require Psychological First Aid but also their relatives and the people who come to assist the survivors.

Disaster Mental Response Handbook, NSW HEALTH, 2002. (pg. 12)

Person who requires Psychological First Aid in context of a disaster would be:• Survivors• First Responders (rescue and recovery personnel and helpers)• Secondary Survivors (friends and relatives of survivors, incidental others upset by

the event and indirectly involved persons)

3Rescue and Recovery personal

Figure: The various disaster victims

2Friends and relatives of Primary Victims

Incidental Others

5Upset by the disaster

6Indirectly involved Persons

Disaster Community

1Primary Victims

4 Community Members

2

3

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General principles of Psychological First Aid1. Intervene immediately (be direct, active and authoritative). The sooner the

survivor is assisted in coping with the disaster or an emergency or a crisis situation, the better are the chances of restoring the pre-disaster situation. The longer the survivor remains in a state of confusion, unable to take some sort of action to address the situation, the more difficult it will be to intervene.

2. Keep the focus of the intervention on the precipitating situation. Help the survivor to accept that the crisis situation has occurred by encouraging the survivor to express the facts of the situation as well as his/her feelings.

3. Provide accurate information about the situation. Give a realistic orientation about what has occurred, and what might be the expected outcomes.

4. Do not give false assurances. Always remain truthful and realistic. Recognize the stress reactions and provide some sense of hope and reassurance that the person will ultimately overcome the crisis. However, let the survivor know that things may never be the same as they were before the crisis.

5. Recognize the importance of taking action. Every psychological first aid intervention should have an ultimate outcome or some action that the individual is able to take. Restoring the person to the position of victor rather than victim is critical to success.

6. Assist in developing networks for survivors. Find a group of peers, family members, community members or church members that can provide both support and temporary assistance during the crisis. Implement a buddy system so that the survivor is not left alone.

7. Focus on personal coping ability. Emphasize how the survivor has coped with the situation so far and how the survivor has already begun to use strategies for moving forward. Encourage the survivor to implement solutions or strategies, which have a high probability of success.

8. Encourage resilience. Provide constructive activities that the survivor can do to assist with the situation, such as helping to put up tents, or distributing food and water in the camp. Reinforce whatever problem solving the individual has demonstrated till this point in time.

9. Be concerned and competent. The more Red Cross volunteers can present themselves as a model of a competent, problem solving individual, and demonstrate the process of taking in information, choosing between alternatives, and then taking action, the more survivors will be able to function adequately. Therefore, it is important that Red Cross volunteers establish their own support systems so that they can adequately cope with the situation.

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Do and Don’t of Psychological First Aid

Do Don’t

1. Contact Listen carefullyCommunicate acceptance.

Tell your “own story” yet.Ignore either facts or feelings.Judge or take sides

2. Dimensions of problem

Ask open-ended questions.Ask person to be specific

Rely on yes/no questions.Allow continued abstractions.Ignore “danger” signs.

3. Possible solutions

Encourage brainstorming.Deal directly with immediate problems.Set priorities

Allow tunnel vision. Leave obstacles unexplored.Tolerate a jumble of needs.

4. Concrete action

Take one step at a time.Set specific short-term goals.Give directions, only if the person needs to go to the health post.

Attempt to solve it all now.Make binding long-term decisions.Be timid.Retreat from taking responsibility when necessary.

5. Follow-up

Make a contract for re-contact.Evaluate action steps.

Leave details up in the air, or assume that client will follow through on plan by her/himself.Leave evaluation to someone else.

Slaikeu, Karl A. (1990). Crisis Intervention: A Handbook for practice and research Allyn and Bacon. (pg. 90)

Demonstration and Practice Guidelines:

• Facilitator demonstrates use of Trifold in the form of a story.• Participants are asked to use similar method to present the Trifold.

How to use the Psychological First Aid Trifolds ?

The PFA trifold is a tool that helps the community-based worker to leaPFA for the people at the community level. It has simple words and isillustrated with bright colors. In the front, it depicts a happy family that undergoes

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a disaster/ crisis. The first fold shows the stress reactions of the husband. In the second and third fold, the five simple steps are given to guide the helper to deliver psychological first aid to the distressed husband.

Activity 8:

Activity-9

Four Role plays Guidelines:

• Select eight participants in four pairs.• Each pair is given a situation where one of the members gives

Psychological First Aid and the other plays the survivor/person in crisis.

• Choose four different situations in which each of the first four steps is respectively projected.

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Group discussion• Divide the participants into groups.• Explain the story of the two sisters. (As in annexure A)• Ask each of the groups to discuss and prepare steps of PFA in the situation. • Each group then makes their presentation.

In giving Psychological First Aid , remember: • This is Psychological First Aid not professional treatment.• Accept the limitations.• Culturally appropriate ways are to be adapted to help people.• Eventually make the survivor self-dependent.

Annex 5.1TWO LITTLE GIRLS…

One day two little girls, named Sita and Geeta and their mother were going back to their house after school. They were talking about their forthcoming exams. Suddenly a cycle rickshaw came and struck Sita! Sita got hurt on her elbow and it was bleeding. She started crying and mother shocked and worried rushed to pick her up. All the people around the scene also came to help Sita.

Meanwhile Geeta was watching all this. She sat on the pavement and started to cry.

Organization of emotional support brigade

• Introduce the term Emotional Support Brigade.• Identify abilities of an emotional assistant.• Learn the process of forming the Emotional Support Brigade.

Psychological First Aid can be applied in an organized and effective manner at the time of disaster in a community if the community prepares a brigade and entrusts it with the responsibility to do so. Such a brigade can be called Emotional Support Brigade.

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6. What is Emotional Support Brigade ? It is a group of people comprising men and women, adults and adolescents who have the capacity of providing Psychological First Aid at the time of an adverse event, to re-stabilize the individual and the support systems of the community.

6.1 What is the purpose of the Emotional Sup-port Brigade ?Purpose of the Emotional Support Brigade is to develop self-confidence, trust and security amongst the people facing a difficult situation and also the first responders.

What are the principles of Emotional Support Brigade ?

The principles of Emotional Support Brigade:Teach the children, adolescents and adults that it is normal to have a series of reactions after an adverse event.Show them how sharing their feelings will help them understand and accept the situation.Reduce the risk of reactions developing into more severe problems (see lesson 6).

6.2 Who can be an Emotional Assistant (member of the brigade offering Psychological first Aid) ?

Activity-10: Role play on the abilities of an emotional assistant

Procedure- One participants will act as a survivor from any crisis/disaster and another participant will act as a emotional assistant. A crisis situation will be given by the promoter. Finally, the whole group of participants will discuss on the abilities of an emotional assistant.

How can Psychological First Aid be applied to the community in disaster?

The Emotional assistant should possess the following abilities:

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He/she should:

• Be a patient listener.• Be available at the time of an adverse event.• Not be judgmental.• Not give his/her own interpretation to the survivor’s story.• Be empathetic.• Be able to observe the survivor’s body language and facial expressions.• Be able to foster immediate coping.• Be able to make the survivors self-dependent.• Be able to respect the dignity of the survivors.• Be able to maintain confidentiality.• Be caring and patient.• Be able to reinforce the feeling of security, hope and trust.• Be able to focus on the immediate needs of the survivor.• Be focused on transforming the situation of being “victims to victors”.

What is Emotional Support Brigade? It is a group of people comprising of men and women, adults and

5.3 How to form the Emotional Support Brigade?

The can be formed in three steps:

Step 1.Recognize the necessity and importance of Emotional Support Brigade in schools, community and the families.

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Identify the existing organizations that can work hand in hand with the brigade.Identify the persons who have the capacity to be a part of the brigade.

Step 2.Establish the protocol for intervention for the situation of emergency.Elaborate the plan of action for the brigade.Organize workshops for children, adolescents, men, women and elderly.

Step 3.Selection of members.Selection of co-ordinator for the brigade.Define roles and responsibilities for the other members of the brigade.Practice the plan of operation.What are the roles of the Emotional Support Brigade in the various phases of the Disaster ?

6.4 Roles of the Brigade before the disaster:Conduct programs to educate the schools and the community. Practice the plan of action at regular intervals.Decide the protocol of interventions.

6.5 Roles of the Brigade during the disaster (0-96hrs):Provide Psychological First Aid to the survivors and the first responders.Conduct the rapid assessment of the number of deaths, injured, homeless, at risk .Re-unite the loved ones.

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Foster the feeling of security and self-confidence amongst the survivors. Conduct activities that bring the community together. For example, community kitchens, religious communes and mass mourning.

6.6 Roles of the Brigade after the disaster (3 months- 2years):Continue to offer Psychological First Aid to the affected people.Conduct group activities to facilitate sharing of feelings amongst the survivors.Conduct activities for recreation for different groups in the community.Provide information to parents about their children’s reactions and how to deal with them.Strengthen support systems. Continue to foster activities that bring the community together.

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PRE/POST EVALUATIONName:____________________________________________Date: ______________

Institute/organization to which he/she belongs:____________________________

Place:_______________________________________________________________

Please encircle the correct answer

1.A person can recover faster after a disaster if s/he has support.

True False

2.When a person is injured s/he needs first aid not Emotional support.

True False

3.One should not accept all the feeling expressed by a disaster survivor.

True False

4.Will power and faith in God are enough to overcome crises.

True False

5.Only a doctor can help a person who is sad and depressed.

True False

6.Consoling is more important then listening in Psychological First Aid.(PFA).

True False

7. Crisis events occur unexpectedly. True False

8. All stressful events are negative. True False

9.Psychological First Aid also involves Physical First Aid.

True False

10. Getting married can be stressful. True False

11. Crisis occur once in a lifetime. True False

12. Psychological First Aid is only for the survivors. True False

13.Only psychologists and psychiatrists can deliver Psychological First Aid.

True False

14.Social and Community networks help individuals cope with Crisis.

True False

15. Psychological First Aid means giving advice. True False

Annex 5.2

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GUIDELINES TO MODULE-V

Day-1S. No. Content Activity Resources Time

1.Recap of the previous day’s sessions Introduction to module-IV

Discussion Presentation

Materials as required 20 minutes10 minutes

2. Pre Test Pre evaluation Test sheets (Annex 4.1) 15 minutes

3.Introduction to Psychological First Aid

Lecture Brainstorm Exercise

Activity 1 60 minutes

4.Concept of Stress & Reactions to Stress

Lecture Brainstorm Exercise

Activity 2 60 minutes

5. Nonverbal communicationLecture BrainstormRole playsDemonstration

Activity 3Activity 4Activity 5Activity 6

90 minutes

6.Psychological First Aid Steps,Situations & Principles

Presentation Demonstration Brainstorm

Activity 7120 minutes

7. Emotional support brigade-roles Lecture Brainstorm Activity 11 60 minutes

Total7 h r s . 1 5 minutes

Day-2

8. Introduction to TrifoldsDemonstration &Exercise

Activity 8 30 minutes

9.Psychological First Aid(Practice: Role play)

5 Role plays- Each emphasizing a step Group activity: Story of two sisters

Activity 9

Activity 10

150 minutes

10. Importance of PFA Lecture Demonstration Materials as required 40 minutes

11.Application in the community/school (Tips)

Discussion 20 minutes

12.Recapitulation of lessons learnt - 2 days

Presentation Brainstorm

30 minutes

13. Post test Post Evaluation Test sheets 15 minutes

Total4 hrs.45 minutes

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Objective:The participants on finishing the module will be able to define and emphasize the objectives of teaching.

Expected Outcome :The participants will be able to :• Use at least three techniques of methods.• Use effectively two methods of teaching.

6Teaching Methods

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Define the fundamental principles of ethics. Define training and information. Move on to management of a class. Elaborate a lesson plan. Use of visual aid. Furnitures and equipment necessary in a training. Methods of evaluation types of tests and exams.

Pre test (Annex 6.1)

1. Information1.1 -Chart of doubts:This chart or poster is used when the main instructor doesn’t have a proper reply to the required doubt of some of the participants and the reply is placed on this chart, in order to be answered along the course or at the end of it.

1.2 -Way of Evaluating the Course:Presentation of the course:

Every person who has received the Course of Methodology for Crisis Intervention, must prepare a Lesson Plan, which will be used to give courses of Psychological First Aid This will serve as a final Evaluation and help establish the quality of the instructor.

1.3 -Nomenclature to be used:MP Manual of the Participants.MD Material of distribution.MR Material of Reference.MI Material for the Instructor.MIE Material Evaluating Instructor.PL Lesson plan.CF FlipchartDP SlideTR Slide sheets.VD Video Cassette.

1.4 -Fundamental Principles of Ethics:No Instructor can object to another one who is conducting a training , if you are present as a participant. On the contrary one should help the instructor to get out from any embarrassing situation.

Introduction

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Will pay attention when any person is speaking (everybody has the right to be listened to).

Don’t neglect any person speaking or answering in an incorrect or inadequate way (Every question or reply is very worthy).

When carrying out a training the instructor cannot give any privilege to any person due to favouritism.

Every instructor has to:1- Dress in a proper manner according to the culture of the community. Not to draw

attention.2- Have the material ready beforehand.3- Study the assigned topic.4- Be well versed with the topic in order to give a better training to the people who

are receiving it.

2. TRAINING AND INFORMATION:2.1- Definition of training:Experience of Teaching-learning designed and practised in such a way that it can guarantee to the participants full realisation of the established objectives. The teaching formation should answer the three basic questions of the training, that are:

1 Where am I heading ? Towards: the Objective

2 How do I reach it ? Through a Methodology.

3 How do I know I have reached it ? Through the Evaluation.

2.2- Aims of the training:To guarantee the capacity for a determined activity, either physical or mental Characteristics of the Training:

Good transmission of knowledge The level of the reached learning can be evaluatedEnables determination of which areas are up to the mark

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It is in keeping with the stated objectives.It is oriented towards a training that implements the objectives. They are achieved through:

• Information.• Interaction.• Evaluation.

2.3 Definition of information:Action that has as an aim to transmit data, opinions, facts and knowledge.

2.4 Aims of the information:Let participants know the contents of a matter, either theoretical or practical.

Features of the information:There is no set rule for judging excellence in performance levels of participants regarding the given information. Lessons are generally from instructor to instructed.The level of learning or knowledge acquired, is difficult to evaluate. The receiver selects freely the information that is presented. The duration of knowledge retained is uncertain. The presentation is done either through a spoken report, or in writing, or by electronic means. When it is spoken the time for questions is very limited and handled only by the presenter.There should be minimum diversion caused by instructor or participants from the topic of discussion

3. Management of a class:3.1. How to use the knowledge of a participant? When we have the participation of people that give opinions or ask questions that will be seen later, then the instructor must return the question to the same person, so he can reply it by himself.

3.2. Flow of ideas:This technique is used when a question is asked and the instructor doesn’t know how to answer it. Then the question is returned to everybody, so everybody can give their opinion and the instructor can obtain the reply with the help of participants.

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3.3. Use of the chart of doubts of Red Cross: When the solution to the required question is not found either by the participants or by the instructor, main or auxiliaries, it will be placed in the chart so that in the next opportunity or before the course or the workshop is over the proper solution can be found.

3.4. How to dress? This will depend on the place where he or she goes to and the type of people with whom we work. For instance: • A formal dress is not to be worn in the communities.• In the student centres it is not recommended to go with buttons or any kind of

ornamentation of the institution because they are a distracting factor for the participants.

• On the business level one has to wear a very formal dress.

3.5. Comunication: 1. Definition: Exchange of understanding between two or more persons

2-Ways to communicate: 2.1-Verbal communication:

• It is the art through which we communicate with each other, through speaking.

2.2- Non-verbal communication:• We can communicate adequately with other people through mime and it can

be done by moving the hands.

3.6. Speech:

Definition:• Art of expressing oneself with propriety, to please, persuade, move or convince

through words.

3.7. Noise, the distracting factor:In any training programme we should find a proper place without noises, because this could distract the participants, and they may not hear the speeches properly, the knowledge they may get could be very distorted In such cases, the Red Cross cannot guarantee the capability of the people supposedly trained.

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4. Elaboration of a lesson plan:4.1. What is a lesson plan ?It is a working guideline that helps the instructor to prepare and present a lecture or of training, according to the mentioned objectives, the profile of the participants and the available resources.

4.2. What is a lesson plan for ?It is a useful guide to help us know what equipment and material are required in the preparation and presentation of the lecture.

4.3. How to make a lesson plan ?The design of any lesson plan must be very simple and should include the methods of use if easily understood, it must never be complex, so that any instructor can use it for an effective training to achieve the objectives previously established.It is suggested that a lesson plan should contain five(5) components or in some cases even less.

1-Introduction:Introduce self , the instructor• Personal presentation of the instructor• Introduction of the Auxiliary instructors.• Introduction of the collaborators• Presentation of the lecture

• Topic to be dealt with• Methodology to be used• Duration of the lecture• Exercises• Workshops in teams.• Evaluation

2. Development of the topic:• This is the main part of the plan related to the preparation and presentation.• This is where the manner and process of presentation of the contents of the topic

is elaborated.

3. Review:• The Instructor will present a brief and very short summary of what he has taught. • He receives the questions from the participants and either he replies to them or

guides them to find the solutions to their questions by themselves.

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4. Evaluation:• This is to verify how much knowledge has been transmitted to the participants

on the topic and if the aims or objectives of the course or workshop have been achieved.

5. Closing:• It is the moment fixed to hand over the MD, MR or any other material that can be

used in the development of the course or workshop, making final recommendations. The lesson or topic being taught next is mentioned.

Note:• In the case of the Red Cross courses, we will count only on the four (4) first

components, because the evaluation of the course will be done at the end of the course in its totality and not at the end of each of the lecture or topic.

Lesson plan

Plan No.

Page.

Course:

Unit:

Estimate duration: Topics to be dealt

Material Contents Observations

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5. How to elaborate on the Visual Aid ?5.1-What is visual aid ?Visual Aid complements the presentation and reinforces the learning and retention of knowledge through visual images or other means.

5.2-What is a flip chart ?This is a big piece of paper of approximately 90 x 70 cms. It is arranged on an easel of the kind the painters use.

The size of graphic material is enough to allocate texts supporting the lecture and the instructor can use them in his lecture.

5.2.1-Features of a good flip chart:• It must show letters with a size of 4 cms. Each one should be seen by every person

and from any part of the classroom. • It must use clear and simple letters, without any ornamentation. • It must use capital and small letters. • It must use a maximum of 10 rows, NOT more. It is suggested that all the letters

are with thick markers and NOT with fine ball point pens. They can be of different colours to make them more attractive.

• Don’t use more than three (3) different colours in one single presentation. • The best kind of paper to be used is the plain white one, without printed lines.

5.2.2-Advantages of flip chart:• It can be used in any place.• It is available anywhere.• It is very cheap.• It is easy to handle and improvise upon.• It doesn’t require electric power.• It can be prepared beforehand• It can be put away and be used later on in a similar training. • It can be written on during the lesson.

5.2.3-Disadvantages of a flip chart:• It is not very appropriate for presenting very complex graphics.• The paper can be spoiled easily.• It can only be used for small groups.• The transport of the easel is a little difficult.

5.3 What is a slide ?It is a still picture on a film that can be projected. The instructor uses it to make a topic clearer, choosing some photographs that show, in a better manner what he means to communicate.

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5.3.1-Features of a good slide:• The suggested size of the letter, in the screen, is of 18 points. You can include, not

only letters but also drawings, photographs, or even graphics.

5.3.2-Advantages of a slide:• Because of its size it is easy to put away. • It screens photographs very clearly. • It can be used in a big space for a lot of people at the same time.

5.3.3-Disadvantages of a slide:• Equipment is expensive:

• Slide projector.• Screen.

• Expensive cost of material• It requires electric power.• It requires complete darkness in the place where it is shown.• The texture of the material is fragile.

5.4. What are acetate or slide sheets ?It is a sheet previously elaborated upon. Usually it is composed in a computer and requires a special projector called Rear-projector to be seen by the participants.

5.4.1-Features of a good slide sheet (TR):It is a visual aid. It can include graphics made with different colours. Each colour will have a meaning, that will be:

• RED Danger• YELLOW Cordiality.• GREEN Welfare.• BLUE Serenity.• PURPLE Formality.

• Any slide sheet (TR) must be loaded with a maximum of ten (10) lines. • The graphics (drawings, charts of bars, charts of circles, etc) must be lightly

loaded.• Any drawing can go accompanied by texts.• It is recommended the size of the letters be between:

• Minimum 18 POINTS. (0.50 c.ms.)• Intermediate 24 POINTS. (0.70 c.ms.)• Maximum 36 POINTS. (1 c.ms.)

5.4.2-Advantadges of a slide sheet:• Easy transport.• It helps in large groups

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• it can be: • Used without completely darkening the room.• Can be written on at the moment of the exhibition.• Made either by acetate or ordinary and regular plastic.

5.4.3-Disadvantadges of a slide sheet:

• It requires expensive equipment, such as: • Rear-projector.• Screen

• They are very fragile• Electric power is required.

5.5. What is a blackboard ?It is the most ordinary visual aid that can be used by an instructor in a training programme.

5.5.1-Features of a good blackboard:• It can be found in any place where there is an area of training, either for companies,

community or educational centres. • There can be different types of blackboards

5.5.1.1-Types of blackboards.• There are two (2) main types, which are:• Fixed on a wall• Portable• They can differ according to the material used.

1-Painted black-boards:It can easily be seen in student centres. These blackboards are usually painted in black or green.

2-Black-boards made of “Sunmica”:These are made of white sunmica, but special markers are needed for this kind of material,

3-Blackboards made of “Duroport”These kinds of blackboards require the use of pins or nails, stick paper or cardboard, that can be elaborate at that very moment or before the training.

4-Black-board made of “Felt”:These can be used when the training programme is for children and it may display drawings for their understanding.

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5.5.2-Advantadges of a blackboard.• It is easy to obtain.• We can erase easily.• It doesn’t require electric power.

5.5.3-Disadvantadges of a blackboard:• It is difficult to carry.• It doesn’t allow for storing information.• It is only for small groups.

5.6. Audiovisual means:It is excellent equipment to use because you can see and hear at the same time. The information you want to give to the participants has a double impact of sight and sound.

5.6.1-Features of a good audio-visual method:• Two (2) machines are to be used, these are:

• Television.• Video-recorder

• It can show a scene, with sound of whatever he is presenting. • Electrical power is required.

5.6.2-Advantages of an audio-visual means:• It allows a complete illustration.• Excellent presentation.• It presents visuals by other means.• Ideal to motivate, move and reflect upon.• It can be used for large groups if there is a provision of a video projector. • Its broadcast reaches any age.• Copies of videocassettes can be reproduced to reduce cost, but the quality reduces

considerably• It doesn’t require full darkness.

5.6.3-Disadvantages of audio-visual means:• It is fragile equipment to carry.• Electric power is required.• A conventional television can cover only small groups • The production of a good quality video is very expensive. • It requires of a specialised personnel.

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6. How do we use our visual aid ?6.1. How do we use a flip chart ?When you count on a Graph paper (PG) to train a group of persons, you must use it in an appropriate way, because if it is not so, you can have a problem instead of a help, and it can also spoil the presentation. We can give some suggestions for proper use.

Novel ways:• Covering the text.• Covering the page to be presented.• Notes in the flip chart. • Preparation of the material beforehand.

7. Training :7.1. Definition of training:To teach in a simple comprehensible way so that a participant can imbibe the knowledge within a short specified time, accomplished stated objectives:

1-Where do I go ?• We have to pre-fix all the objectives we intend to achieve.

2-How do I reach them ?• We have to elaborate all the means to get the training to happen, through a proper

methodology.

3-How do I know that I have reached ?• We will verify the achievement of the objective through the evaluation.

7.2. Goals of the training:To guarantee the capacity to perform any specific activity, either physical or mental.

7.3. Features of the training:• A good transmission of knowledge is guaranteed.• Learning through communication is obtained.• It determines which tasks are accomplished.• It is in line with the contents that correspond to the objectives. • It leads to the achievement of the objectives, as well as the performance and the

training.

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• They achieve through the presentation that contains:• Information• Interaction• Evaluation

7.4. Methods of Training:• Set of procedures oriented to the completion of the pre-established objectives, in

the process of teaching learning.

1-Self-teaching:• It is one of the most used methods in individual teaching and it depends very

much on the personal interest, helping in achieving of knowledge.

Means such as these are used:• Books.• Magazines.• Video- cassette.• Cassette for video-recorders.

2-Lecture by a professor:• n this kind of teaching the professor talks and the students listen and take

notes.

3-Interactive teaching:• The instructor makes a presentation of knowledge, skills and abilities about a

specific topic towards a particular objective

C.1-Sharing technique:• Audio-visual means either by training or through performance.• The interactive system of learning, for the completion of the objectives.

Flow of ideas.A. Team workB. Drama performances

• Among the interactive methods of teaching we can mention:

C.1.1-Programmed book:• During the reading of the book, the participant has the chance to interact with

it.

C.1.2-Study of cases:• It is based on facts or real situations.

C.1.3-Electronic means:• Through already programmed computers.• Through a video or audiocassette.

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C.1.4-Simulation and pretence:Simulation• It is a laboratory exercise, a game of roles, which are carried out in a classroom.

Pretension:• t is a drama presentation that is carried out directly in the place where the problems

will occur..

NOTE:In the training, both are activities that must be preceded by teaching the necessary skills and knowledge to solve the problems which are staged.

C.1.5-Systematising

• It is a participative method that is used in communities and is popular, being a reflection of the experiences. It is introduced in three important phases:• Experiences.• Orientation• Practice

C.1.6-Demonstration and practice:• It is used to teach ‘teaching psychomotor actions’, that is purely practical; such

as - undo, assemble, adjust, put together, and operate.

C.1.7-Interactive presentation:• This is one of the ways of the “interactive method of teaching”, which is mostly

used for the training of people because the interaction is for the instructor as well as for the participants.

8. Furniture and Equipment:8.1. Appropriate conditions for a classroom:• Good lighting/enough light.• The best location should be a place where there is not much noise.• Appropriate ventilation.• Proper furniture depending on the kind of training to be given. It could be:

• Desks, if it would be a professor lecture.• Tables and chairs, if it is for an interactive training.• Without any kind of furniture if it is to be a demonstrative training.• For audio-visual presentations ,electric power is needed to connect the

necessary equipment machinery, such as:• Rear-projector.• Slide projector.• Television• Video-recorder.

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8.2-Placing of the furniture and equipment ac-cording to the type of training:

Different options for the placing of the equipment in a large classroom will be shown, according to the type of training:

Lounge for Lectures

Lounge for Interactive Training in “U” shape

Lounge for Interactive Training in “V” shape

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Lounge for Interactive Training with desks in “Rows”

Auditorium

Area for practice

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Lounge with desks for Practice

Lounge for Large Sessions

8.3- Equipment necessary in a training is ac-cording to the requirements of the participants:

1- Community based:Usually in these places we do NOT have electric power, so only a previously elaborated PG is needed, and a few in white along with some markers of different colours. This is to be able to distribute them for different groups. .The ideal material required per community is as follows:• 50 sheets for PG in white colour.• 8 markers of BLACK colour (Permanent)• 8 markers of BLUE colour. (Permanent)• 8 markers of RED colour. (Permanent)• 2 markers for blackboard of BLACK colour. (Not Permanent)• 2 markers for blackboard in BLUE colour. (Not Permanent)• 2 markers for blackboard in RED colour. (Not Permanent)• 1 eraser to clean the blackboard.

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2- Centre for Students:These places have electric power, so CF, TR, DP and VD can be used and the requirements are more, and among them we can mention:• Television and video-recorder.• Rear-projector.• Slide projector.• Screen• Set of:• Slide sheets (TR)• Slides. (DP)• Videocassettes. (VD)• flip chart (CF)• Easel for the (CF).• 50 sheets for the white (CF).• 8 markers of BLACK colour (Permanent)• 8 markers of BLUE colour. (Permanent)• 8 markers of RED colour. (Permanent)• 2 markers for blackboard in BLACK colour. (No Permanent)• 2 markers for blackboard in BLUE colour. (No Permanent)• 2 markers for blackboard in RED colour. (No Permanent)• 1 eraser to clean the black-board

3- Companies and Industrial zones:As in the student centres, the COMPANIES do have electric power, so we can use PG, TR, DP and VD, so the requisites are larger, and among them we can mention:• Television and video-recorder.• Rear-projector.• Slide projector.• Screen• Set of:

• Slide sheets (TR)• Slides. (DP)• Video-cassettes. (VD)• flip chart (CF)

• Easel for (CF).• 50 sheets for white PG.• 8 markers of BLACK colour (Permanent)• 8 markers of BLUE colour. (Permanent)• 8 markers of RED colour. (Permanent)• 2 markers for blackboard in BLACK colour. (No Permanent)• 2 markers for blackboard in BLUE colour. (No Permanent)• 2 markers for blackboard in RED colour. (No Permanent)• 1 eraser to clean the black-board

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9. Methods for Evaluation9.1-Definition of evaluation:Verification the achievement of the objectives by a test or exam through which the participant will show that he has reached the required level.

9.2-Types of tests and exams:In order to have a better criterion for the results, in the Red Cross a series of exams are conducted, among them we can mention:

1-Test or exams on knowledge:

1.1-Definition• It is the confirmation of the acquired knowledge on the part of the participants,

through a test, either in oral or in written exam.

1.2-Written exam:• It is the test or exam that is given to the participant in a written form. Among

them we can mention:

1.2.1-Fill up the blanks:• In this kind of test or exam, a sentence is written and the participant has to

complete it.

1.2.2-Multiple choice:• In this kind of test or exam, a question mark is pointed out and among 4 or 5

answers, only one is correct or incorrect.

1.2.3-True or False: • Certain statements are made. The Participants have to recognise them as being

correct or incorrect, that is, true (if correct) or false(if incorrect)

1.2.4-Searching of answers: • There are two columns. One has definitions, the other has the topics. The right

topic has to be paired with the right definition.

1.3-Oral exam:• In this kind of test or exam direct questions are made to the participants who

answer orally.

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2- Test or exams of performance, aptitudes and skills:

2.1-Definition:

This kind of test or exams brings out the knowledge applicable to the skills that each participant can show after a training.

2.2-Theoretical and practical test:

In this kind of test or exam they verify the knowledge as well as the skills that a person can achieve after the adequate training in the area of formation and orientation of the Red Cross, to be able to offer appropriate attention to all those who are in need.

2.2.1-Pretence/make-believe.• It is an activity that is carried out directly at the same place where, probably, the

problem will happen.

WORKING GROUP:

Working Groups prepare material for the presentation of Psychological First Aid Course. They are often formed from outside the Red Cross members. Can be other volunteers from within the community/ group to be trained. s The material that they must have are:A- flip chart (CF).B- Lesson plan. (PL).C- Some additional visual materials.

INTERACTIVE PRESENTATION:This will be carried out in groups, previously formed to impart the Course of Psychological First Aid, in a period of 16 hours.

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Tips for Instruction:

Learner

Facilitator Instructor

• Put on difference roles according to the participants, situations, objectives of training.

• Be comfortable. • Trust your group. They will take you through your lesson.• Be friendly and open to new learning.

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PRE/POST EVALUATIONName:____________________________________________Date: ______________

Institute/organization to which he/she belongs:____________________________

Place:_______________________________________________________________

(Mark your response in the box:)

Q .No.

QuestionStrongly Agree

AgreeStrongly disagree

DisagreeDon’t know

1.

‘Every question or reply is very worthy’is one of the fundamental principles of ethics.

2.‘Learning through communication is guaranteed’ not a characteristic of training.’

3.While attending a classroom a formal dress with any kind of ornament is not a distracting factor.

4.A lesson plan is not a working guideline that helps the instructor.

5.

The features of a flip chart must show letters with a size of 8 c.ms. and should be seen by a particular person.

6.The disadvantage of a slide requires complete darkness in the place where it is shown.

7.Blackboard is the most ordinary visual aid.

8.

‘To guarantee the capacity to perform any specific activity. Either physical or mental’ is a feature of the training.

9.Interactive teaching includes sharing technique.

10.Simulation means a drama presentation.

Annex 6.1TAECHING METHODS

Annex 6.1

Module 6: Teaching Methods

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SESSION GUIDELINES TO MODULE-VI

Contents Activity Resources TimeRecap of the previous day’s sessionsIntroduction to module-VI

Discussion Presentation

Materials as required

20 minutes10 minutes

Pre test Pre evaluation Test sheets 20 minutes1.Information 1.1 chart of doubts.1.2 Fundamental principles of ethics.

LectureBrainstormDemonstration

Materials as required

30 minutes

2.Training and information2.1 Definition2.2 Aims 2.3Characteristics

3. management of a class3.1 how to use the knowledge of a participants.3.2 Flow of ideas3.3 How to dress?3.4 Speech and noise.3.5Communication

LectureBrainstorm

Presentation by the participants

Materials as required

40 minutes

30 minutes

4. Elaboration of a lesson plan.4.1 What is lesson plan?4.2 How to make a lesson plan ?

BrainstormDemonstrationPresentation by the participants

Materials as required

60 minutes

5. How to elaborate on the visual aid ?5.1 What is visual aid?5.2 What is graph paper (PG)?5.3 Advantages and disadvantages.5.4 what is a slide?5.5 what are slide sheets?5.6 what is blackboard?5.7 what is audio visual?

Lecture

Brainstorm

Presentation by the participants

Materials as required

30 minutes

60 minutes

6. How do we use our visual aid?6.1 How to use a graph paper.7. Training 7.1 Definition7.2 Goals 7.3 Features7.4 Methods.

Lecture

BrainstormPresentation by the participants

Materials as required

60 minutes

8. Furniture and equipment.8.1 Appropriate conditions for a classroom.8.2 Placing of the furniture and equipment.8.3 Necessary equipments in training.

LectureBrainstormPresentation by the participants

Materials as required

30 minutes

30 minutes

9. Methods of evaluations.9.1 Definition9.2 Types of tests and exams.

LectureBrainstormPresentation by the participants

Materials as required

40 minutes

Post Test Post Evaluation Test sheets 20 minutesTotal 8 hour

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COURSE EVALUATION

CHECK YOUR ANSWER:

1. How would you rate the quality of the follow-up training sessions ? Excellent Good Fair Poor 2. Was the speed of delivery of presentation: Too fast Too slow Just right

3. Did you think the topics were relevant ? If so: Yes, very relevant Not at all relevant Some what

4. Would you recommend more sessions like this in your community ? No, definitely not Yes, maybe Yes, definitely.

5. Do you think the topics of the session will help in your daily life ? Yes, they will No, they will not To some extent.

6. Do you feel better prepared to deal with a disaster or a crisis now ? Yes, definitely Not at all To some extent

7. Do feel better prepared to assist someone affected by a disaster or in a crisis ? Yes, definitely Not at all To some extent

8. Would you like to attend another session like this in the future ? Yes, definitely Not at all To some extent

9. Was the language of the sessions easy to understand ? Yes Not at all To some extent

10. Was the training environment comfortable for learning ? Yes, very No, not really It was ok.

Do you have any other comments ?

Annex no: 6.2

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REFERENCES:

• Biel Soro, D. Barbosa, M F, Lopez Donis, M., Silva, M C. Aguilera, K (2001). Manual de Intervention Psicosocial para promotores y promotoras. Managua, Nicaragua: Cruz Roja Espanola/ Cruz Roja Nicaragua.

• Bryce, C.P (2001). Stress Management in Disasters. Emergency Preparedness and Disaster relief Coordination Program. Washington.D.C: Pan American Health Organization. World Health Organization.

• Bryce, C P (2001). Insights into the Concept of Stress. Emergency Preparedness and Disaster relief Coordination Program. Washington.D.C: Pan American Health Organization. World Health Organization.

• Center for Mental Health (2000). Disaster Mental Health Response Handbook. North Sydney, NSW

• Cohen, R E (2000). Mental Health Services in Disasters: Instructors Guide. Mexico. Washington.D.C: Pan American Health Organization/Editorial El Manual Moderno

• Curtis, R (1995). Outdoors Action Guide to Group Dynamics and Leadership. Princeton, New Jersey: Princeton University.

• George, S M. (2001). 'Emergency Mental Health Care'. In Abdallah, S & Burnham, G. (Eds). Public Health Guide for Emergencies. Baltimore, MD: The John Hopkins University, School of Public health.

• Gupta, M C. Sharma, V K. Gupta, L C. Tamini, B K. (ed) (2001). Manual on Natural Disaster Management in India, National Centre for Disaster Management. New Delhi: IIPA

• International Federation of Red Cross (2003). Psychological Support Policy. Geneva, Switzerland: IFRC

• Myers, D (1994). Psychological Recovery from Disaster: Key Concepts for Delivery of Mental Health Services. NCP Clinical Quarterly.

• Moya Pinto, Margarim (2000). Salvd Mental en el Afronte de Desastres. Lima, Peru: Instituto Nacionac de Salvd Mental.

• National Institute of Mental Health (2002). Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence. A workshop to reach Consensus on Best Practices. NIH publication NO.12-5138, Washington D.C: US Government Printing Office

• Prewitt Diaz, J O. (2003). The Training Model. New Delhi, India: Indian Red Cross Society

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• Prewitt Diaz, J O, Escorcia Delgadillo, Josefina. E, Flores Gonzales. B. A (2002).• Diplomado para Interventores en crisis: Guia Metodologica. Guatemala: Cruz• Roja Gautemalteca/ Cruz Roja Americana

• Prewitt Diaz, J O (2002). Apoyo Psicosocial en Desastres un modelo para• Guatemala: Guatemala: Cruz Roja Guatemalteca/ Cruz Roja Americana

• Rodriguez, J (Ed) (2002). Protection of mental health in disaster and emergency situations, Washington, D C: Pan American Health Organization

• Saakvitne, K W, Pearlman, L A (ed) (1996). Transforming the Pain: a workbook on Vicarious Traumatization. New York: Norton.

• Sekar, K Bhadra, S. Jayakumar, C (2003). My Workbook. Workshop on Psychosocial aspects in Disaster Management. Department of Psychiatric Social Work. Bangalore: NIMHANS

• Slaikeu, K A. (1984). Crisis Intervention, A Handbook for Practice and Research. Second Edition. Boston: Allyn and Bacon

• WHO/EHA (2002). Disasters and Emergencies: Definitions. Pan African Emergency Training Centre. Addis Ababa.

• WHO (2003). Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors. Geneva: WHO. WHO/MSD/MER/03.01

• Young, M A (1998). Community Crisis Response Team Training Manual, Second Edition. Washington, D C: National Organization for Victim Assistance

• Bryce.C.P(2001)Stress Management in Disasters. Emergency Preparedness and Disaster relief Coordination Program. Pan American Organization. World Health Organization. Washington.D.C.

• Bryce.C.P(2001)Insights into the concept of stress. Emergency Preparedness and Disaster relief Coordination Program. Pan American Organization. World Health Organization. Washington.D.C.

• Cohen.R.E(2000)Mental health services in disasters: Instructors guide. Pan American Health Organization/Editorial El Manual Moderno,Mexico. Washington.D.C.

• Curtis, R(1995)Outdoors Action Guide to Group Dynamics and Leadership. Princeton: New Jersey. Princeton University.

• Disaster Mental Health Response Handbook (July 2000). Center for Mental Health, North Sydney, NSW.

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• Lòpez M.J., Escorcia J., CRA. (2003). Manual Para Brigadas De Apoyo Emotional. Cruz Roja Americana.

• Lonigan CJ, et al: (1994), Risk factors for the development of post-traumatic symptomatology, Journal of the American Academy of Child & Adolescent Psychiatry, 33(1): 94-106.

• Myers.D(1994). Psychological Recovery from Disaster: Key Concepts for Delivery of Mental Health Services. NCP Clinical Quarterly.

• Moya Pinto, Margarim (2000) Salvd Mental en el Afronte de desastres. Lima, Peru: Institute Nacionac de Salvd Mental.

• Norwood AE, et al: (2000), Disaster Psychiatry: Principles and Practice, Psychiatric Quarterly, 71(3): 207-226.

• Prewitt –Diaz J.O. (). Primeros Auxilios Psicològicos. Cruz Roja Americana.

• Slaikeu K.A. (1984) Crisis Intervention, A Handbook for Practice and Research, Second Edition. Allyn and Bacon, Boston.

• The Sphere Project (2004) The Sphere Project. Humanitarian charter and Minimum Standards in Disaster Response. The Sphere Project, Geneva

• WHO/EHA (2002) Disasters and Emergencies: Definitions. Pan African Emergency Training Center, Addis Ababa.

• WHO (2003) Mental Health in Emergencies: Mental and Social Aspects of Health of Populations Exposed to Extreme Stressors. WHO: Geneva; WHO/MSD/MER/03.01

• Young.M.A(May 1998). Community Crisis Response Team Training Manual: Second Edition. National Organization for Victim Assistance, Washington, D.C.

The Sphere Guidelines and Mental and Social Aspects of Health.A group of NGOs across the globe joined the Red Cross and Red Crescent movement to form the Sphere Project, in 1997. Their objective was to strengthen the services offered, with a minimum standard of quality and inherent accountability. Disaster affected people were to be helped to a life with dignity. The aim of the sphere project is to improve the quality of humanitarian assistance provided to people affected by disasters, and to enhance accountability in disaster response.Standard III mental and social aspects of health:People have access to social and mental health service to reduce mental health morbidity, disability and social problems.

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Guidelines1) Information should be disseminated according to the principles of risk

communication. Access to information reduces unnecessary public anxiety and distress.

2) Burials Families should have the option to see the body of a loved one after his/her death if allowed by their cultural norms. Hasty and uncaring disposal of bodies of the dead should be avoided.

3) Psychological first aid acute distress among the general population or among aid workers following exposure to extremely stressful conditions is best managed by the principles of psychological first aid. It focuses on• Listening rather than enforcing talk;• Assessing needs and ensuring that the basics are met• Encouraging social contact and• Protecting people from further harm.

This type of first aid can be taught to both volunteers and professionals. Health workers are cautioned not to prescribe powerful medicines because of the risk of dependence.

4) Care for urgent psychiatric complaints Urgent psychiatric conditions such as psychoses, severe depression and mania can

be dangerous to oneself and others. These should be referred to psychiatrists and mental health experts.

5) Community based psychological interventions These should be based on an assessment of existing services and an understanding of the socio-cultural context. Coping mechanisms to help individuals and communities gain a control over the circumstances, must be functional and culturally acceptable. To better help the vulnerable and minority groups, community workers must be trained to assist health workers and conduct outreach activities.