1. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Magda Rooze MA/MBA director Impact Madrid, 8 February 2010 GUIDELINES

2. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Overview Introduction Why guidelines? The Dutch multidisciplinary guidelines on early psychosocial interventions The ‘European value’ of the Dutch guidelines on early psychosocial interventions The Dutch multidisciplinary guidelines for uniformed aid workers

3. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Introduction /Main activities Impact Advice for professionals, policy makers, managers Gathering and sharing information –(Digital) Knowledge base –(International) congresses/conferences –Workshops and seminars –Publications –Newsletters Developing standards and guidelines

4. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Some Publications Impact Together smarter / advice for interest groups of victims Multidisciplinary guidelines on early intervention World of difference / personal experiences of professionals and victims Musical / resilience for children Process model for the long term afterphase ‘Strong Shoulders’ / personal experiences of uniformed aid workers

5. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Why guidelines?  ?   Support instrument for practice No protocol, no ‘turn-key solution’ Contribution to high-quality, evidence based psychosocial care

6. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Guideline development Specific methodology Systematic literature research Scientific research Best-practices Consensus Authorisation (commitment) evidence based

7. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 What to do and what not to do during the first 6 weeks following disasters, terrorism or other shocking events/incidents. –Supportive context –Preventive early interventions –Curative early interventions –Organization Dutch guidelines on early psychosocial interventions

8. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 A supportive context Practical support Providing information: Comforting explanation of normal reactions Indicate when it is necessary to seek professional help Advise to take up normal daily routine as soon as possible Show empathy Promoting the use of victim’s private supportive network

9. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Preventive interventions: Psychological triage “ Trained volunteers and relief workers play an important role in recognising those affected with psychological and/or serious clinical symptoms that require diagnosis and/or treatment” Triage: identifying the need for psychosocial care

10. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Preventive interventions: Debriefing “A strong advise against (one-off) psychological debriefing with the aim to prevent PTSS and other psychological problems.”

11. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Curative interventions: Treatment of symptoms Follow existing symptom-specific guidelines, protocols and standards As regular as possible; as culture-specific as possible. Acute Stress Disorder, serious symptoms of post traumatic stress and PTSS (>4 weeks): Trauma-focused cognitive behaviour therapy (CBT).

12. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Organization Within legal boundaries As regular as possible Collective interventions: –Crisis/relief centre / assistance and support in acute stage –One-stop shop function –Communication via the media

13. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 The ‘European value’ of the Dutch guidelines on early psychosocial interventions Questionnaire: –Agreement with guidelines recommendations (35 items) –Opinion –Practice –5 point Likert scale Expert meeting: –60 EU scientists, policy makers and (mental health) experts in the field of post disaster psychosocial care –25 countries in EU

14. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 The ‘European value’ Overall: large overall agreement on the recommendations ‘Stage of development’ differs between countries Opinion does not equate practice (neither in The Netherlands or in the EU) Debriefing remains a controversial issue

15. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 The ‘European value’: debriefing NL vs EU

16. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 The ‘European value’ of the Dutch guidelines Experts agree on the importance of implementation Already much ‘good practice’ in EU countries concerning provision of information However, the ‘stage of development’ is very different between countries, psychosocial interventions do not always have a high priority in policies In some countries CBT is not the ‘intervention of choice’ More emphasis on children is perhaps needed

17. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Dutch multidisciplinary guidelines for uniformed aid workers Why this guideline? Methods Preliminary results

18. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Why this guideline? Uniformed aid workers are repeatedly exposed to potentially shocking events Organisations are legally, economically and morally obliged to ensure adequate (after)care for their employees

19. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 ‘Facts & Findings’ Prevalence of PTSD varies strongly among aid workers: 0% - 50% In general: −10-20% PTSD −0-27% Depression −0-19% Anxiety −3-25% Alcohol abuse −5-20% General psychological complaints −5-55% Unexplained physical complaints PTSD more prevalent in uniformed aid workers than in general population Need for multidisciplinary approach −Differences between professional aid organisations −Differences within organisations between regions

20. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Preliminary results Stepped care model (Gersons, 2005) Applicable to all professional aid services Leaves room for interpretation

21. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Preliminary results 2 Focusgroups: Despite differences many similarities –Need for factfinding –Need for recognition –Timing of care –Blame

22. impact Seminar Resilience Development Madrid, 8 & 9 February 2010 Guidelines, not tramlines !