Psychoeducation, Psychological first aid, Psychosocial support, terminology"

Transcription

1 Psychoeducation, Psychological first aid, Psychosocial support, terminology" ENPS Forum 2013, Istanbul B. Juen University of Innsbruck Austrian Red Cross

2 Aim of the presentation To give an overview of the definitions for the most used terms in the field of psychosocial support as well as the state of the art in the three areas Psychosocial support Psychological First Aid Psychoeducation

3 Psychosocial Support Psychosocial support (PSS) is an umbrella approach, following the intervention principles named by Hobfoll et al. (2007) with the aim of promoting resilience of individuals, groups and communities in crisis. Psychosocial support includes a broad variety of interventions promoting the resources of individuals, families or groups as well as the community as a whole.

4 Providing psychosocial support to affected people can be done in many different ways The aim is to establish a resilience promoting context by the use of various programmes and activities e.g. Community outreach encouraging and supporting community initiatives, such as home-based support, school-based interventions, vocational and skills based trainings, establishing community centres establishing support groups e.g. Psychological First Aid being available and assessing needs contacting relatives giving information organizing practical matters E.g. Psychoeducation giving information and enabling dialogue about stress reactions and good ways of coping

5 Some examples of psychosocial support activities Source: IFRC Reference Centre for Psychosocial Support Beslan: After the Beslan school siege in 2004, the International Federation and the Russian Red Cross established a community centre, a visiting nurses programme and summer camps for the affected children. Sierra Leone: In Sierra Leone, girls who had been abducted and sexually exploited by armed groups often experienced stigmatization and harassment when they returned. Community dialogue helped local people understand the girls and Girls Well-Being Committees imposed fines for mistreatment of the girls. Both initiatives reduced abuse and supported their reintegration into the communities. India: A mourning house was established on the edge of a mass grave in one of the areas affected by the Indian Ocean tsunami, where people could enter to have a moment of silence. The house later developed into a community centre.

6 State of the art In psychosocial support you should focus upon the five key elements Safety Connectedness Self and Collective Efficacy Calm Hope Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, P. R., De Jong, J. T. V. M., Layne, C. M., Maguen, S., Neria, Y., Norwood, A. E., Pynoos, R. S., Reissman, D., Ruzek, J. I., Shalev, A. Y., Solomon, Z., Steinberg, A. M., Ursano, R. J. (2007): Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry 70 (4),

7 Umbrella approach versus intervention strategies Psychosocial support is the umbrella approach on the level of intervention design Psychological first aid and psychoeducation are intervention strategies within the approach

8 Psychological First Aid Psychological First Aid (PFA) is an element of psychosocial support that can be effectively applied by trained lay-people including volunteers but is also used by professionals.

9 New material on Psychological First Aid rkers/ Psychological first aid: Guide for field workers Authors: WHO, War Trauma Foundation and World Vision International Publication details Number of pages: 64 Publication date: 2011 Languages: Arabic, Chinese, English, French, Japanese, Korean, Romanian, Spanish. ISBN:

10 Psychological First Aid (PFA) PFA is an intervention form that contains the following elements Providing practical care and support, which does not intrude; Assessing needs and concerns; Helping people to address basic needs (for example, food and water, information); Listening to people, but not pressuring them to talk; Comforting people and helping them to feel calm; Helping people connect to information, services and social supports; Protecting people from further harm. (World Health Organization, War Trauma Foundation & World Vision International (2011). Psychological first aid: Guide for field workers. WHO: Geneva)

11 Psychological First Aid involves the following key activities Principle Actions LOOK. Observe for safety. Observe for people with obvious urgent basic needs. Observe for people with serious distress reactions LISTEN Make contact with people who may need support Ask about people s needs and concerns Listen to people, and help them to feel calm LINK Help people address basic needs and access services Help people cope with problems Give information Connect people with loved ones and social support

12 State of the art Do not use classical active listening which is too confrontational (do not focus on emotions, stay on cognitive level) Focus on needs, practical and emotional support (information, being active, connecting and use of resources) Help people protect themselves and regulate their stress (calm) go with the symptom, help people to distance themselves, encourage self protection Freeman, C, Flitcroft, A, & Weeple, P. (2003) Psychological First Aid: A Replacement for Psychological Debriefing. Short-Term post Trauma Responses for Individuals and Groups. The Cullen-Rivers Centre for Traumatic Stress, Royal Edinburgh Hospital. Ehlers, A, Clark, D M (2003) Early psychological interventions for adult survivors of trauma, Journal of biological Pschiatry, 53, pp

13 Psychoeducation Education refers to the provision of knowledge and skills to a given target group which involves teaching that can be done in a broad variety of ways. Psychoeducation means the provision of information to the affected persons and groups as well as the initiation of a dialogue about the nature of stress, posttraumatic and other symptoms, and what to do about them. The provision of psychoeducation can occur before possible exposure to stressful situations or after exposure. The intention is to ameliorate or mitigate the effects of exposure to extreme situations.

14 Psychoeducation is an important aspect in psychosocial support programmes and training Examples from the IFRC Reference Centre Training materials

15 Information education and communication (IEC) materials Four brochures Stress and coping Children s stress Working in stressful situations Psychological First Aid Three information sheets Supporting volunteers (for NS) Info sheet for ERU staff, All children deserve to be safe

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17 State of the art Be aware of possible medicalisation and too much confrontaion Do not use formal classical debriefing Do not be too confrontational (no pressure to talk about the details of the event and the emotional side of the experience) Do not do formal screening but do risk assessment Do not predict symptoms, but make people understand their reactions Do not be too educational (some researchers prefer the term psychoinformation) Focus on positive coping and resilience Rose S, Bisson J, Churchill R, Wessely S. (2007) Psychological debriefing for preventing post traumatic stress disorder (PTSD) (Review) In: The Cochrane Library, 2007, Issue 1

18 Summary/Framework Psychosocial Support (PSS) An umbrella approach directed at individuals, families, groups and communities in crisis. Based upon the five principles named by Hobfoll (safety, connectedness, selfcollective efficacy, calm, hope). Aim: enhancing resilience. Psychological First Aid (PFA) An intervention strategy under the PSS umbrella aimed at individual(s) and groups in acute crisis, a humane and supportive response to a suffering human being that can be provided by lay people. Aim: reducing acute stress and promoting active coping and use of resources Psychoeducation An educational intervention (two way process) under the umbrella of PSS aiming at enhancing an understanding of stress reactions and promoting positive coping (in the Hobfoll scheme it is mainly the principles of calm and efficacy that are active here)

19 How do the three terms connect in practice? Persons doing psychosocial support have to be able to 1. Develop programmes and/or activities for people in crisis that fit the five principles of Hobfoll and enhance the resilience of individuals, families and communities in crisis. These programmes/activities have to be adapted to the needs of the given individuals and groups, context, situation, culture and community, community outreach is an important aspect 2. Use Psychological First Aid as a Strategy in actually communicating and interacting with people in acute crisis with the focus on safety, connecting, activation of resources and self protection 3. Use Psychoeducation when being in contact with higly distressed individuals and groups in order to help them understand their reactions and make use of positive coping strategies with the focus on stabilisation and resilience

20 Resumee Therefore PSS trainings have to involve all three elements Psychosocial support (Knowledge about grief, stress, resilience, the five elements of Hobfoll and how to translate them into action and develop PSS community outreach programmes) Psychological first aid (Knowledge about how to approach persons in acute crisis, how to assess their needs, how to support them practically and help them to stay active, how to protect them from too much confrontation and how to connect them with further social support) Psychoeducation (Knowledge about stress, its course and ways of coping as well as being able to use a variety of didactic ways to inform the affected individuals and communities about stress and positive coping without being too confrontational and too eduactional)

21 Thank you for your attention