The European Network for Traumatic Stress Training & Practice

Community Interventions Dean Ajdukovic

Learning outcomes Upon completion of this module, the participants should be able to: 1.Describe the impact of traumatic events on communities 2.Describe specific approaches to effective interventions for communities

Contents What are community-based interventions Impact of traumatic events on communities Stages of community recovery affected by disaster Vulnerable groups requiring special attention Specific approaches to effective interventions for communities

What are community-based interventions? Activities that facilitate normalization of social, family and individual psychosocial functioning in a community affected by a disaster in order to: Promote a sense of safety, self and community efficacy/empowerment, connectedness among community members, and increase hope in recovery of individuals and the community Provide support and treatment to people with difficulties in family, work or social functioning

Destroyed homes and fragmented communities make survivors highly vulnerable  the priority is safety Finding missing family members is the primary concern of survivors Overwhelming demand for support while natural support systems are shattered  need for immediate and organized psychosocial support and care Impact of traumatic events on communities after a disaster

Loss of work and opportunity to support own family increases helplessness People are concerned that the communities will not recover which increases hopelessness People may experience loss of control over own life Likely increase of family violence, child abuse, substance abuse Impact of traumatic events on communities after a disaster

Stages of community recovery from disaster Initial stage (within first week) - people display: Overwhelming feelings of fear, terror and anxiety Thought confusion Behavioral disorganization and difficulties in decision making Concern with wellbeing of about important others

Stages of community recovery from disaster Second stage (within the first month): Strong bonding emotions and empathy among survivors, non-victims and helpers Massive aid from authorities and other communities, attention from the media help people feel of being supported and connected

Stages of community recovery from disaster Third stage (several months after a disaster): The interest and support of the wider society decreases, leaving the survivors in the affected community feel left alone to struggle with the recovery and rebuilding issues People often complain about various needs that are not fulfilled as promised, including the care for the trauma sufferers

To start functioning normally as soon as possible Look forward to the hard work of rebuilding their homes and lives as a challenge Leave their suffering behind, together with their traumatic experiences and symptoms The society expects the disaster survivors and their communities:

Target groups for community interventions Circles of vulnerability include people who have been exposed to traumatic experiences and a disaster at different intensity: –Those directly involved and their families –Witnesses, friends and “near misses” –Emergency personnel and helpers These groups should have access to a range of psychosocial care interventions

Circles of Vulnerability

Vulnerable groups requiring special attention Children and adolescents since their development can be affected by exposure to trauma and extreme distress Elderly who depend more on other people for a variety of services Pregnant women, single parent families who are more dependant on organizational support from the family

People with chronic illness who may need special medical attention or assistance to access services Children and youth without parental support and supervision People with health-related dietary needs People who do not understand language, procedures, legal requirements (e.g immigrants, minority group members) Vulnerable groups requiring special attention

Children and adolescents have increased need for care Communities and families focus on rebuilding infrastructure, homes and jobs which absorbs most of their time and energy, neglecting the increased needs for support and care among children and adolescents Highly distressed adults sometimes do no recognize increased emotional needs of children and adolescents, and provide too little support before psychological and/or behavioral difficulties externalize

Social support after disasters Social support includes providing information, help with practical issues and meeting the socio-emotional needs As the basic needs are met (food, water, shelter and safety), the psychological defenses diminish, and the awe of the reality may become overwhelming that individuals become numb and feel powerless, unable to make decisions and maintain active coping

Community-based interventions should enhance the coping capacity: Individuals: To deal with disturbing posttraumatic reactions and integrate traumatic experiences and losses Communities: To find culturally appropriate ways to deal with losses and ensure a safe environment which is conductive to healing Community interventions

Practical help given in an empathic manner Emotional support and initial reassuring of distressed individuals Providing information (e.g. tracing family members, accessing temporary housing, food, social benefits, access to health, psychological, legal services) Material assistance (e.g. providing housing, food, financial benefits, rebuilding infrastructure) Specific approaches to community interventions:

Employment (e.g. retraining to increase employability and independence) Facilitating mutual support and special interest groups Providing psychosocial care interventions to the affected population Organizing memorial events and building monuments with active participation of the disaster survivors Specific approaches to community interventions:

Community interventions: Providing information Setting up the information center for survivors and care providers, with web-site and telephone response service Publication of information for victims, family members, aid personnel Contact details of authorities and services that are responsible for different aspects of disaster response

Community interventions: Providing information Education about psychosocial consequences of disasters Information about variety of available mental health services and referral procedures Collecting and analyzing victims’ questions and securing responses

Community interventions: Material assistance and benefits Identification of people and families that are in need and entitled to material assistance and benefits Dissemination of information to these people Organizing orderly and transparent distribution of assistance Providing legal advice about insurance and compensation

Community interventions: Housing and rebuilding Housing and infrastructure rebuilding is a key element in bringing the populations back to their original communities after a disaster Providing building materials, loans and know-how facilitates community rebuilding Rebuilding institutions (schools, health clinics, communal services) are essential for the normalization of life patterns

Community interventions: Employment provisions Training and retraining people to increase their qualifications and competitiveness at the job market Tax plans that stimulate investments in the affected community Communal services that hire primarily the people with poor employability Providing loans to start small businesses or buy agricultural equipment

Community interventions: Psychosocial services Psychoeducation about ‘normal reactions to abnormal situations’ for specific groups (e.g. adolescents, children, elderly, parents, teachers, community workers) Support groups with special interests, backgrounds or experiences (e.g. survivors of family losses, families with missing family members) Informal, recreational and creative activities using the local tradition and culture

Identification and referral of individuals with disturbing posttraumatic psychological functioning Psychological counseling, grief work Support and consultation by mental health providers to the staff in community institutions (schools, community clinics, churches, youth clubs) to help re-establish normal routines and work with highly distressed users Community interventions: Psychosocial services

Advising community authorities on the mental health issues Networking with providers in communities with similar experiences Develop and put in place evaluation procedures that will demonstrate the effectiveness and accountability of services

* Psychiatric medication * Treatment of dysfunctional traumatized clients * Individual, family, group counseling * Loss, grief and worry work * Psychological evaluation and referral * Social and life skills building groups * Self help and mutual support groups * Emotional support provisions by trained para-professionals * Guidance in structuring free time * Networking (e.g. youth, elderly, special needs groups) * Family reunification * Training of care-providers and dissemination of skills and knowledge * Public awareness of “normal psychological reactions to abnormal situations” * Information on accessing other services, about legal status, missing ones * Facilitating basic social structures, institutions, roles and responsibilities Number of clients served / allocation of resources Pyramid of community psychosocial intervention (Ajduković, 1997; Ajduković & Ajduković, 2003) Level of service expertise

Community interventions: Developing local psychosocial service capacities Training local care-providers to increasingly take over responsibilities for psychosocial services This is the key to ensuring sustainable community services that will be needed years after a disaster  outside assistance is always time limited

Staff-related issues Because of high workload, difficult working conditions and a large number of distressed individuals, the psychosocial staff is exposed to high levels of professional stress and vicarious traumatization Procedures should be provided that help prevent burnout, regular supervision, consultation with peers and outside consultants, opportunity for professional growth and facilitating supportive team spirit

Consider the time Community interventions in the aftermath of a disaster need time to yield results The affected population is highly distressed and typically impatient to see improvement in own mental health and well-being as well as the community rebuilding Those involved in providing community interventions have to deal with two conflicting qualities: work hurriedly and be patient