State of the Art on Psychosocial Interventions after Disasters

1. State oftheArt on PsychosocialInterventions after Disasters Barbara Juen IPRED Tel Aviv January 13, 2014

2. OPSIC • Project aimingat • Operationalizingpsychosocialsupport in crisis • Staticpartofplatform (glossary, toolbox, guidelinesandhandbooks, comprehensiveguideline) • Flexible partofplatform (OGS tobeusedbyaffected, crisismanagersandhelpersbefore, duringand after crisis)

3. Analysis ofguidelinesandhandbooks In total weanalysed 324 guidelinesandhandbooksregarding • Content/Phases, Event types, targetgroups/ keyrecommendations/ethicalaspects/genderaspects/culturalaspects • Quality/Procedureofdevelopment, scientificcriteria

5. Ethicalaspects in disasters • Process of decision making (where all actors involved in decision making? Where they given sufficient information? see Svedin, 2011, p.13) • Behaviours of decision makerswhether or not leaders acted according to certain values (e.g. Human rights), which parts of their decision they make visible and which not and for what reasons • Judgement of whether decision makers should have acted or become involved at all (Svedin 2011)

6. Ethicalaspects • Ethical aspects in disasters mentioned in the guidelines involve the aspects of Due Process, Dignity and Human Rights, Non-Discrimination, Privacy, Confidentiality and Data protection, Transparency and Accountability(focussed mostly on behaviour of decision makers and helpers but less on process of decision making and judgement or whether involvement was right) • Dilemmas arise especially around human rights, unequal distribution of disaster risk and vulnerabilities, the question of who has the right and who has the duty to intervene, the question of who is informed and how much and who gives information, the possible negative effects of the media as well as the unequal distribution of support especially the question of not supporting vulnerable groups because of various reasons. • Ethical communication means that governments establish a fair and open dialogue with all stakeholders that aims at consensus (Olsson, 2011).

7. Cultural aspects • Cultural aspects in disaster guidelines are often reduced to cultural differences in mourning and social behaviour. It is stated that helpers should come from the local culture and local culture has to be involved in decision making • But: Looking closer at cultural aspects in disasters we soon realize that culture is a dynamic, nonhomogenous concept and is closely interlinked with other aspects that define power relations in society like ethnicity, gender and class • The general trend in the future therefore is to look not only at differences between and within groups but also at inequalities between and within groups and communities

8. Gender aspects • Gender is often treated in the guidelines as a mere issue of vulnerability and protection • But: The gender perspective in disasters has shown, that an intersectional approach is called for. Gender like culture may not be treated as a standalone category • Looking at gender in disasters the following aspects should be taken into account: capacities and strengths of women, household structure, gender politics, inequalities and intersectionality, men and women, women´s groups

9. Key recommendations • Guidelines havemanysimilarities • Theymayfocus on different aspects but in generalthereis a broadconsensus

10. Key findingsfromtheevidence • Resilience approach (individuals and groups can be supported to make use of resources and come back to normality) • Most trauma reactions are normal and transient and have a broad variety (normalize reactions, inform about reactions and coping but be aware of medicalisation and too much confrontation) • Importanceof secondary stressors (e.g. resource loss, lack of social support) • There is a need for both psychosocial and mental health care (stepped approach, multi layer approach) • The majority of the affected do not need specialized mental health care but still need psychosocial support (psychosocial before clinical approach) • 5 effective principles of intervention by Hobfoll(2007) (safety, connectedness, calm, self and collective efficacy, hope) • Screen for risk factors (symptom screening lateron and not for everybody)

11. Core Principles • Use Needs orientation • Use Anticipation, Planning, Preparation and Advice • Focus on Families and Communities • Develop, Sustain and Restore Psychosocial Resilience • Ensure human rightsandequity • Ensureparticipation • Do noharm • Buildon availableresourcesandcapacities • Useintegratedsupportsystems (no stand aloneservices) • Usemulti-layeredsupports

12. Key interventions • PsychosocialsupportaccordingtotheHobfollprinicples (umbrellaapproachfor all phasesusing different interventionformats) • Psychoeducation (informationaboutreactionsandcoping)usedialogue, beawareofmedicalizationandtoomuchconfrontation • Psychological firstaid (intervention in theveryacutephase) accordingtothe WHO principles(Observeforsafety, listen toneeds, connecttofuthersupportandsocialnetworks)

13. Resumee • Broadconsensus in suggestedinterventionformatsandtheimportanceofprevention • Broadconsensus in keyinterventionsresppsychologicalfirstaid, psychoeducation, psychosocialsupport • Gaps regardingethics, genderandculture • Gaps regardinglongtermsupportandlongtermeffects

14. Thankyouforyourattention