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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 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
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Psycho Social Support- An Overivew Article-3

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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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Page 1: Psycho Social Support- An Overivew Article-3

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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