Psychosocial Support: An overview Psychosocial support: An overview of a program to enhance resilience and improve well-being in disaster-affected people Joseph O. Prewitt Diaz 1 1 . Dr. Prewitt Diaz is a humanitarian Psychologist with over 30 years of experience in community based psychosocial programs in disasters. He served as the Senior Advisor for Psychosocial Support for the American Red Cross during the 2004 South Asia Tsunami, and developed a program that served over 750,00 beneficiaries. Currently Director of the Disaster Law Center and Visiting Professor at the School of Law, University of Puerto Rico. He is the recipient of the 2008 APA International Humanitarian Award. 1
This paper discusses how a community based psychosocial support program increases participation of disaster-affected people in their reconstruction as a result of an improvement in their psychosocial well-being. The article is divided into three parts: (1) the early beginning of community initiative and civic engagement approach called VESPRA, (2) the systematization of the model into a community based psychosocial support approach and (3) a practical application of the model in a real disaster. The paper concludes that the development of a theoretical and practical model, the systematization of that model into a community based psychosocial support approach and an the application of such an approach enhanced the psychosocial well being of disaster affected people.
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Psychosocial Support: An overview
Psychosocial support: An overview of a program to enhance resilience and improve well-being
in disaster-affected people
Joseph O. Prewitt Diaz1
1. Dr. Prewitt Diaz is a humanitarian Psychologist with over 30 years of experience in community based psychosocial programs in disasters. He served as the Senior Advisor for Psychosocial Support for the American Red Cross during the 2004 South Asia Tsunami, and developed a program that served over 750,00 beneficiaries. Currently Director of the Disaster Law Center and Visiting Professor at the School of Law, University of Puerto Rico. He is the recipient of the 2008 APA International Humanitarian Award.
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Psychosocial support: An overview of a program to enhance resilience and improve well-being
in disaster-affected people
Abstract
This paper discusses how a community based psychosocial support program increases participation of disaster-affected people in their reconstruction as a result of an improvement in their psychosocial well-being. The article is divided into three parts: (1) the early beginning of community initiative and civic engagement approach called VESPRA, (2) the systematization of the model into a community based psychosocial support approach and (3) a practical application of the model in a real disaster. The paper concludes that the development of a theoretical and practical model called VESPRA, the systematization of that model into a community based psychosocial support approach and an the application of such an approach enhanced the psychosocial well being of disaster affected people.
Key Words: psychosocial support, resilience, well-being, disaster affected people
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Psychosocial support:
An overview of a program to enhance resilience and improve well-being in disaster affected people
IntroductionPsychosocial support has been identified as a positive tool to alleviate
suffering of disaster-affected people, enhance resiliency and foster psychosocial well-
being (Hobfoll et al. 2007; Prewitt Diaz 2010). This paper provides a historical
overview of community based psychosocial support (CBPSP), proposes a model of
the sector as a platform to foster community resilience and enhance well-being, and
concludes with an operational community based psychosocial support program.
I. Emergence of community initiatives and civic engagement
In early 1965, psychosocial support was chosen as a viable strategy for
community development in Puerto Rico, through a group that called itself VESPRA
(Voluntarios en Servicio a Puerto Rico en Acción) (Pond, 1968). VESPRA was a
community program that used principles of psychology, participatory actions, and
voluntarism to re-establish sense of place and improves well-being among target
communities. The methodology evolved rapidly to a systematized approach better
known today as community based psychosocial support (American Red Cross, 2002).
This model has been successfully used as a disaster response tool (See SPHERE,
2011, pp. 14-77).
Three principal theories were used in the formulation of the VESPRA
psychosocial support program: (1) Client centered and non-directive theory used to
work closely with the community (Rogers, 1951: Rogers, 1961); (2) the introduction
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of therapeutic communities (Jones 1962), and (3) the use of group therapy as a model
that focused on the promotion of well being in community groups (Slavson, 1962).
This non-directive method permitted assessment to be carried out where the neighbors
expressed themselves and were inspired to believe that there future was in their hands,
their actions led to improved lifestyle and the community was improved (Bolton &
Tang, 2002) .
The volunteers established relationship with community members in a
supportive environment where the volunteer and community member saw themselves
as equals. The volunteer was not perceived as an outsider, and the community
members were perceived as inherently good, and therefore should be encouraged and
supported to achieve their full potentials.
By assuming responsibility for their own actions, community members
became resilient, moved forward, grew, and achieve their full potential, thus
achieving a sense of well being. Through common activities, community members
tended to be concerned for one-another, behave in an honest, dependable and
constructive manner.
The first strategy used from the 60’s was small group training sessions. Basic
to VESPRA training and field operations is the small group of peers. VESPRA basic
tool for training, and community groups was the T-group pioneered by Kurt Lewin
(1890-1941) and researchers in the National Training Laboratories in Washington.
The group methodology was used in an eclectic fashion by many different trainers
and community settings.
The results of the theories developed by Rogers were gauged by improved
self-esteem, reported increase in trust in one’s inner feelings, and the experiences as
valuable sources of information for decision making; increased ability to learn from
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experiences and not make mistakes, and more positive and comfortable relationships
with others. In a recent meeting former volunteers sharing their VESPRA experience
of their 70’s and 80’s reported that the training had increased their capacity to
experience and express feelings at the moment they occurred, and an openness to new
experiences and new ways of thinking about life. They felt that they were more
resilient and attributed their current success to their volunteer experience.
A second strategy adopted from the 60’s was the consideration of the
community as a therapeutic environment. Jones (1962) introduced into the field of
social psychiatry the use of groups in communities, hospitals and prisons. The
Therapeutic Community offers a safe environment with a clear structure of
boundaries and expectations where members have the opportunity to come to terms
with their past through re-enactment within a treatment setting involving other
members and staff. Therapeutic communities offered the individual experiences to
awaken creative and social abilities. Members tend to learn much through the routine
interactions of daily life and the experience of being therapeutic for each other.
Through the strategy of therapeutic community, the aim is to encourage
members towards a better understanding of their previous behavior and to enable
them to improve their inter-personal functioning, first within the therapeutic
community and ultimately in the wider community. Encouraging and reinforcing the
notion of personal responsibility and sharing, members and staff meet together on a
regular basis to discuss the management and activities of the community.
Understanding mechanisms of action in group psychotherapy was beneficial
for the growth of the group. During training sessions, the facilitator, recognize that the
success of individual group members is intimately linked to the overall health and
well being of the group-as-a-whole. Indeed, a sizable portion of the clinical and
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empirical literature delineates therapeutic factors and mechanisms that have been
linked with healthy well-functioning therapy groups. Mechanisms of action are
interventions that are considered to be causal agents that mediate client improvement.
These mechanisms take many forms, including experiential, behavioral and cognitive
interventions.
VESPRA started out with the premise that human beings are responsible for
themselves. Human beings have the legal and social responsibility to make decisions
affecting their behavior and impacting their future. The goal was to confront the poor
with this reality, and it gave the poor the tools of group motivation to begin the
process of changing their traditional responses toward their internal and external
environment.
The program addressed the following social and psychological needs:
1. In the individual: Thee technique encouraged disaster
affected members to change their own attitudes of helplessness and
dependence. The disaster-affected people are encouraged to test out
new modes of behavior that lead to produce greater personal
effectiveness. Once the community members have begun to feel a
sense of freedom, and capacity springing from their own behavior, the
disaster affected people are encouraged to join a group and conduct
assessments in their communities to search out and assist other
community members who felt the same way.
2. In the family: The disaster affected families are
encouraged to engage in community activities that will increase the
security in which children and adolescents can develop and family
solidarity can become more of a reality, not only an ideal, day care
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center for children of working mothers, recreational programs of all
sorts, neighborhood health promotion organizations, evening
vocational training classes for adults and adolescents are some of the
most common projects that were implemented during the first ten
years. Especially important is developing protected and secure
environments where the weaker members of the community could
develop themselves become resilient. Once family members identify
an interest of fostering community growth, then all the disaster-
affected families can come together and progress toward collective
well-being.
3. In the community: Develop, with community
organizations that will learn to function effectively in solving
identified problems of the neighborhood/place which can be tackled
by the people themselves using the community human capital, without
outside assistance. At the same time, work to establish a
place/neighborhood that can represent the disaster affected people in
confronting outside stakeholders.
4. In the larger community. Identify the social capital
available outside the place that might be brought to bear on the social,
environmental and psychological needs of the community.
The one benefit in this four-pronged approach was that in building the
capacity of the community members to care for themselves and all other
neighbors, to train themselves in leadership skills and to involve all the members
in self-help solutions to the internal situations and community problems, produces
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a feeling of resilience and well-being that breaks barriers and reduces the outside
society efforts to isolate, suppress, and exploit the disaster-affected people.
In the next forty years the program evolved into a community and school
based psychosocial support program that was adopted in Central and South America
and Asia during major disasters.
II. From community initiatives through VESPRA to community based psychosocial support
In 1998, with Hurricane Mitch hitting the Central American countries and
causing thousands of deaths, loss of properties in the millions of dollars and extensive
human suffering, a psychosocial support model was developed following the
VESPRA model. This model required a minimum amount of per person cost, and was
potentially a mechanism to empower the community to organize, protect and
reconstruct itself. This model was unlike standard models of aid giveaway programs.
The evolution of psychosocial support programs has corresponded with the
increasing severity of disasters and the emergence of international guidelines
(SPHERE Project 2011, IASC/MHPSS, 2007). The American Red International
Services adopted the proposal of developing psychosocial support programs and
generated draft guidelines to systematize the program within the repertoire of disaster
response options (American Red Cross, 2002). In Posoltega, Nicaragua (1998), the
psychosocial support program coordinated the response of 21 local Non Government
Organizations (NGO’s) to a major mudslide that killed over 2,000 people and left
over 13,000 injured (Prewitt Diaz & Saballos Ramirez, 2000). Lessons learned as a
result of this experience focused on types of intervention and early coordination
among stakeholders. In another major disaster, i.e. the El Salvador earthquake (2001),
the psychosocial support program-focused on developing an immediate psychosocial
response mechanism and psychological first aid was used as a tool during the relief
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and response period (Jaquemet, 2001). In 2003, the Indian Red Cross Society (IRCS)
and the American Red Cross defined the psychosocial personnel needs during a
disaster and designed a course of study for technicians, specialists, and professionals
(Prewitt Diaz, Srinivasa Murthy & Lakshminarayana, 2004). By 2004, the Indian
personnel had developed a systematized approach for community based psychosocial
support that included group training; community participatory assessment, staff
development (from the community to the University), and monitoring and evaluation
mechanism have been developed.
Community based psychosocial support was implanted in parts and as an
integrated model during the 2004 tsunami by the American Red Cross International
Services. The figure below introduces a schematic of an integrated model, where
psychosocial support is used as a platform to initiate community response
immediately after a disaster. The integrated program is a follow-up to the guidance
proposed by the Health Standard of the SPHERE Project (2004, p.197-199), and the
request from the funding agency to utilize the “project cycle” methodology to plan
and develop the program.
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FIGURE 1: COMPONENTS OF ENGAGING THE COMMUNITY IN A COMMUNITY BASED PSYCHOSOCIAL SUPPORT PROGRAM (CBPSP). EACH COMPONENT IS EXPLAINED BELOW.
The goal of community based psychosocial support program to Improve the
capacity of the community so that it becomes “Physically, mentally healthier and
become a better-prepared community”. There are six steps in the process of engaging
the community in the project development: (1) assessment and planning, (2)
articulating the strategies, (3) defining the interventions, (4) community engaging in
small projects to identify the interest of existing human capital, (5) the outputs, and
the (6) impacts.
Assessment and planning
Community volunteers are identified and a basic training is conducted in topics of
psychological first aid, participatory assessment and community mapping. The
premise for this activity is that disaster affected people know best what their
community looked like prior to the disaster, what has happened in their community,
and what should take place to recover and enhance resilience.
The activities during this initial phase are to encourage disaster affected people to be
active in identifying what activities provides participation to all segments of the
community, look forward so that they may overcome the initial feelings of
hopelessness and helplessness, and by taking action steps, plan projects that will shift
the power dynamics and foster resilience.
The disaster affected people take an active role in the identification and analysis of
needs, project development and decision-making about their priorities and the vision
about their future.
Articulating strategies
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Community members are encouraged to become engaged in activities that will foster
their growth in an inclusive way. These activities may include, and are not limited to,
(1) providing accurate and timely information about resources, services, and common
reactions, (2) the disaster affected people provide human capital, (3) the disaster
affected people provide materials, cash and labor, while technical assistance is
provided by outside stakeholders, or (4) the disaster affected people may act
independently from external sources.
Defining Interventions
Once the broad strategies have been identified then the interventions are tried
out. This is time to experiment with activities and identify the best match between
disaster-affected people and the broad strategies. For example some people will
engage in sharing information, others will want to construct, others do psychological
first aid, and yet others conduct informal educational session for youth.
In planning the initial interventions the disaster-affected people have to cycle
through five core interventions of a community based psychosocial support program.
These interventions are: (1) providing accurate and timely information, (2) formal and
informal educational experiences, (3) identifying and enhancing support and
resources, (4) increasing access for all the community population, and (5) monitoring
and reporting.
Community and school activities
The initial response has been initiated the disaster affected people are busy in the
rehabilitation and reconstruction of their respective places and communities. The two
settings in which most of the activities will occur are the community and school. At
the community level activities include improving the environment and reconstructing
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place. In the schools, the efforts are in re-establishing formal schooling for children
and adolescent and in conducting informal schooling activities for youth and adults in
the community. The emphasis is on getting everyone engaged in reconstruction. All
projects are considered and supported by the coordinating committee of the disaster-
affected people. Eventually the social capital is identified, and small community-
wide projects, and income generating activities get on their way. Usually psychosocial
support activities serve as the platform for other more concrete projects.
This is a good time to initiate to document community engagement in its
rehabilitation and reconstruction, specific actions taken are documented, and change
by the disaster affected people are recorded. The adaptation of the disaster affected
people into the new community life, institutionalization of changes, and capacity
building are monitored and reported as a success toward enhancing resilience and
well-being.
Outputs
Re-establishment of place and community development don’t occur in a neat
sequential manner. Important actions occur according to the situation. If a community
is able to successfully bring about changes, their capacity to create even more
community changes related to the group's mission should improve.
Among the important outputs is that trust is generated to the point where the
community works in shared common risks and protective factors. More than one
community formulate a partnership to elicit funds from an outside stakeholder may be
related to new community changes and desired outcomes.
Different initiatives may work well in the disaster-affected community and
foster growth thus the importance of being flexible in adapting interventions. This
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creates an approach that "belongs" to community members, has been modified to fit
community needs, and through changing interventions to fit local needs, community
members improve their ability to take care of their own problems.
Impact
The impact of a community based psychosocial support program can be
measured by the amount of involvement of the disaster affected people in the
reconstruction activities, the development of trust in thee actions of all segments of
the community, and the desire to volunteers to achieve well being for the total
community. Re-establishment of place as measured by sharing of cultural activities,
problem solving, solution-focused activities, identification of social capital, and care
for the environment is a second impact. The third impact is an increase of physical
and emotional well being amongst the disaster-affected people.
III. An operational Community Based Psychosocial Support Program (CBPSP) model
This section presents a case study of an actual project that was implemented in
Sri Lanka after the 2004 tsunami. It explains the school and community-based
interventions. These types of activities were used throughout this program in order to
facilitate the involvement of the whole community of disaster-affected people
including elderly, physically handicapped, widows and children in its recovery
process. The activities were geared to assist the survivors to rediscover their
psychosocial well-being by enhancing their own protective factors. All the activities
were planned, executed, monitored and evaluated by the community members along
with personnel from a local Non-Government Organization to ensure that they are
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culturally appropriate and sustainable. An external stakeholder provided financial and
technical assistance to conduct interventions in target communities and schools.
Not everyone felt comfortable expressing him or herself verbally after the
tsunami. Creative and expressive activities such as story telling, art and crafts
provided creative ways for disaster-affected people, often children or older members
of the community, to communicate their feelings. Community based skits and story
telling proved to be a powerful and effective way of venting feelings; it’s a simple
healing process with enjoyment and togetherness. These types of activities were used
in both the school and community focused activities to facilitate expression of
feelings, to reduce distress and to enhance a sense of belonging. They provided a
conduit for disaster-affected people to have a sense of place by: (1) accepting
responsibility for their place (village or community), (2) developing a knowledge base
about their physical, psychological, social and human village, (3) living in the place
and enjoying the available facilities, (4) mapping the place, (5) building the physical
infrastructure of the place, and (6) taking action to preserve the place.
The project goal was to: Enhance resilience through a community
based psychosocial support program (CBPSP). The following objectives and
activities supported the development of the project.
Objective 1: Promote psychological and social well-being of the community through schools
Resilient Schools
In order to recognize and enhance resilience in the school community the
program facilitated psychosocial activities in target schools. The objective of these
activities was to involve the school community in creating a ‘Happy School’. A
“Happy School” is defined as a school building that is secure provides space for
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dialogue between teachers and students, and where students were encouraged to
become actively engaged in all activities. Eventually, the activities were channeled
towards preparing the school to face a crisis, emergency or disaster. The skills of the
students, teachers and volunteers were enhanced to develop a ‘School Crisis Response
Plan’, with the help of school mapping and formation of four school committees
composed by students, teachers, other school personnel and parents.
During the first year and a half of the program the “Resilient Schools”
program was implemented fifty-one schools in target districts. This model was
replicated during the second half of the program. Each participating school received
three school chests, one recreational kit, and one large first aid kit per classroom per
year, one individual first aid kit per student, and financial support for two school
resilience activities and six student-parent activities per year.
Model Schools
During their third, year of teacher training, pre-service teachers are paired with an in-
service teacher, generally at a government school, in order to gain practical
experience. Working with each National Colleges of Education, the program selected
up to 5 schools receiving student teachers in each district to be “Model Schools”. In
order to be selected, the school met the previously established criteria of being
partially damaged by the tsunami or hosting Internally Displaced children. The
program provided support to these pre-service teachers and their in-service mentors to
implement aspects of the “Resilient Schools” program in their classroom. Each
classroom in these model schools received a first aid kit, recreational kit and school
chests. The CBPSP Educational Specialist monitored the student teachers and
provided them support to practice their new skills in order to organize model schools
in target areas.
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In year one the model school component reached forty classrooms as pre-
service teachers were trained from Jan to May 2005. In years two and three 825 in-
service teachers were trained annually. About 40,000 students were served through
this program.
Objective 2: Strengthen community protective factors
Resilient Community program
The objective of the activities under the “Resilient Communities” program were to
bring diverse groups within the community together to prepare for, respond to and
recover from crisis, emergency or disaster. This program began with participatory
focus groups with groups of ten families. A Community Liaison team led these focus
groups in planning the activities. During these focus groups, participants were given
an overview of the goals of the CBPSP program and worked together to identify
community needs, possible solutions and resources available within, as well as
outside the target community. During this period the focus group leader identified
those members of the group with an interest in becoming a Community Facilitator.
The 4,000 trained Community Facilitators were divided into groups of five.
Each group of five worked with 50 families units; defined for the purpose of this
program as a village. The Community Facilitators received a variety of support
materials to assist them in preparing their “village” to recognize potential
psychological risks among members and to develop a plan to address those issues.
They worked with their village to identify two “skills building” activities annually.
The nature of these activities were determined by the village members and included
training, tutoring for children or income generation activities. The objective of these
activities was to facilitate a sense of security and unity and to recognize and enhance
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resilience factors within the village. Villages were required to submit a “proposal” for
these activities to their Community Liaison for review and approval.
Informal Schooling
The CBPSP program supported informal schooling for children under five and
out of school youth in the target communities. This aspect of the CBPSP program
brought together several marginalized groups; handicapped individuals, elderly,
widows, out of school youth, and children under five. Structures were identified
within the community to house the informal school. Each of these schools were
provided with a recreation kit and other CBPSP materials. Education within these
schools were facilitated by the Community Facilitators and led by the trained Informal
School Teachers. During the morning, activities focused on education for children
under 5. The Community Facilitator and Informal School Teacher included adults and
adolescents from a variety of marginalized groups in providing education to and
activities for this group. In the afternoon activities focused on education for out-of-
school youth and tutoring for children who needed extra attention. In addition these
informal schools served as a venue where community elders came together to educate
children about culture and to enhance vocational skills. Breakfast and a fortified
snack will be served to students and teachers attending the school.
Objective 3: Assist Community Members to establish a “sense of place”
The program provided and environment where disaster-affected people were
able to establish a “sense of place” by providing opportunities to engage in social
encounters, encouraging movement between social groups (individual to social
interaction, small group to large group), providing opportunities for self expression
through creative and expressive activities, and opportunities to express a full range of
behaviors including exploration, competition, and collaboration. All planned
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activities improved social comfort, collective well-being, social equity and respect
and the opportunity to make sense of an environment, changed by the tsunami.
In order to facilitate a sense of unity within the community, the program
supported the development of “community centers.” These centers brought together
representative from all parts of the community to plan and implement community
well-being strengthening activities. The centers became the hub for CBPSP activities;
from planning activities, to bringing persons together and linking with external
organizations. These day-to-day interactions motivated disaster-affected people to
establish a sense of place by: (1) accepting responsibility for their village, (2)
developing knowledge about their village (watershed, soils, climate, plants, and
animals), (3) enjoy the facilities available, (4) mapping the village, (5) building the
physical infrastructure of the village, and (6) taking action to preserve their village.
Summary and Conclusion
This paper narrated the formation of an idea for community development using
volunteers, participatory approaches based on the teachings from the field of
psychology and mental health. The paper relates how the original idea (VESPRA)
evolved into a community based psychosocial support model. The systematization of
the model in Central and South America by the American Red Cross was conducted
in the early part of the 21st century. Finally, using CBPSP as a platform for disaster
response during the 2004 tsunami in Sri Lanka, the methodology was fine-tuned. The
third part of the paper presents an example of how CBPSP was used in schools and
communities in Sri Lanka.
The beginning of the 21st century ended the debate over the role of disaster
response. It has been agreed by humanitarian actors need to address assistance and
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protection (SPHERE, 2011). The project described herein is one alternative that
proved successful in alleviating suffering and enhancing psychosocial well-being
using strategies that provided assistance and protection to all.
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