The European Network for Traumatic Stress Training

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The European Network for Traumatic
StressTraining Practice

• www.tentsproject.eu

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Community Interventions

• Dean Ajdukovic

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Learning outcomes

• Upon completion of this module, the participants
  should be able to
• Describe the impact of traumatic events on
  communities
• Describe specific approaches to effective
  interventions for communities

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Contents

• What are community-based interventions
• Impact of traumatic events on communities
• Stages of community recovery affected by
  disaster
• Vulnerable groups requiring special attention
• Specific approaches to effective interventions
  for communities

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What are community-based interventions?

• Activities that facilitate normalization of
  social, family and individual psychosocial
  functioning in a community affected by a disaster
  in order to
• Promote a sense of safety, self and community
  efficacy/empowerment, connectedness among
  community members, and increase hope in recovery
  of individuals and the community
• Provide support and treatment to people with
  difficulties in family, work or social
  functioning

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Impact of traumatic events on communities after a
disaster

• Destroyed homes and fragmented communities make
  survivors highly vulnerable ? the priority is
  safety
• Finding missing family members is the primary
  concern of survivors
• Overwhelming demand for support while natural
  support systems are shattered ? need for
  immediate and organized psychosocial support and
  care

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Impact of traumatic events on communities after a
disaster

• Loss of work and opportunity to support own
  family increases helplessness
• People are concerned that the communities will
  not recover which increases hopelessness
• People may experience loss of control over own
  life
• Likely increase of family violence, child abuse,
  substance abuse

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Stages of community recovery from disaster

• Initial stage (within first week) - people
  display
• Overwhelming feelings of fear, terror and anxiety
• Thought confusion
• Behavioral disorganization and difficulties in
  decision making
• Concern with wellbeing of about important others

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Stages of community recovery from disaster

• Second stage (within the first month)
• Strong bonding emotions and empathy among
  survivors, non-victims and helpers
• Massive aid from authorities and other
  communities, attention from the media help
  people feel of being supported and connected

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Stages of community recovery from disaster

• Third stage (several months after a disaster)
• The interest and support of the wider society
  decreases, leaving the survivors in the affected
  community feel left alone to struggle with the
  recovery and rebuilding issues
• People often complain about various needs that
  are not fulfilled as promised, including the care
  for the trauma sufferers

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The society expects the disaster survivors and
their communities

• To start functioning normally as soon as possible
• Look forward to the hard work of rebuilding their
  homes and lives as a challenge
• Leave their suffering behind, together with their
  traumatic experiences and symptoms

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Target groups for community interventions

• Circles of vulnerability include people who have
  been exposed to traumatic experiences and a
  disaster at different intensity
• Those directly involved and their families
• Witnesses, friends and near misses
• Emergency personnel and helpers
• These groups should have access to a range of
  psychosocial care interventions

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Circles of Vulnerability
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Vulnerable groups requiring special attention

• Children and adolescents since their development
  can be affected by exposure to trauma and extreme
  distress
• Elderly who depend more on other people for a
  variety of services
• Pregnant women, single parent families who are
  more dependant on organizational support from the
  family

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Vulnerable groups requiring special attention

• People with chronic illness who may need special
  medical attention or assistance to access
  services
• Children and youth without parental support and
  supervision
• People with health-related dietary needs
• People who do not understand language,
  procedures, legal requirements (e.g immigrants,
  minority group members)

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Children and adolescents have increased need for
care

• Communities and families focus on rebuilding
  infrastructure, homes and jobs which absorbs most
  of their time and energy, neglecting the
  increased needs for support and care among
  children and adolescents
• Highly distressed adults sometimes do no
  recognize increased emotional needs of children
  and adolescents, and provide too little support
  before psychological and/or behavioral
  difficulties externalize

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Social support after disasters

• Social support includes providing information,
  help with practical issues and meeting the
  socio-emotional needs
• As the basic needs are met (food, water, shelter
  and safety), the psychological defenses diminish,
  and the awe of the reality may become
  overwhelming that individuals become numb and
  feel powerless, unable to make decisions and
  maintain active coping

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Community interventions

• Community-based interventions should enhance
  the coping capacity
• Individuals To deal with disturbing
  posttraumatic reactions and integrate traumatic
  experiences and losses
• Communities To find culturally appropriate ways
  to deal with losses and ensure a safe environment
  which is conductive to healing

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Specific approaches to community interventions

• Practical help given in an empathic manner
• Emotional support and initial reassuring of
  distressed individuals
• Providing information (e.g. tracing family
  members, accessing temporary housing, food,
  social benefits, access to health, psychological,
  legal services)
• Material assistance (e.g. providing housing,
  food, financial benefits, rebuilding
  infrastructure)

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Specific approaches to community interventions

• Employment (e.g. retraining to increase
  employability and independence)
• Facilitating mutual support and special interest
  groups
• Providing psychosocial care interventions to the
  affected population
• Organizing memorial events and building monuments
  with active participation of the disaster
  survivors

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Community interventionsProviding information

• Setting up the information center for survivors
  and care providers, with web-site and telephone
  response service
• Publication of information for victims, family
  members, aid personnel
• Contact details of authorities and services that
  are responsible for different aspects of disaster
  response

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Community interventionsProviding information

• Education about psychosocial consequences of
  disasters
• Information about variety of available mental
  health services and referral procedures
• Collecting and analyzing victims questions and
  securing responses

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Community interventions Material assistance and
benefits

• Identification of people and families that are in
  need and entitled to material assistance and
  benefits
• Dissemination of information to these people
• Organizing orderly and transparent distribution
  of assistance
• Providing legal advice about insurance and
  compensation

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Community interventions Housing and rebuilding

• Housing and infrastructure rebuilding is a key
  element in bringing the populations back to their
  original communities after a disaster
• Providing building materials, loans and know-how
  facilitates community rebuilding
• Rebuilding institutions (schools, health clinics,
  communal services) are essential for the
  normalization of life patterns

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Community interventions Employment provisions

• Training and retraining people to increase their
  qualifications and competitiveness at the job
  market
• Tax plans that stimulate investments in the
  affected community
• Communal services that hire primarily the people
  with poor employability
• Providing loans to start small businesses or buy
  agricultural equipment

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Community interventionsPsychosocial services

• Psychoeducation about normal reactions to
  abnormal situations for specific groups (e.g.
  adolescents, children, elderly, parents,
  teachers, community workers)
• Support groups with special interests,
  backgrounds or experiences (e.g. survivors of
  family losses, families with missing family
  members)
• Informal, recreational and creative activities
  using the local tradition and culture

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Community interventionsPsychosocial services

• Identification and referral of individuals with
  disturbing posttraumatic psychological
  functioning
• Psychological counseling, grief work
• Support and consultation by mental health
  providers to the staff in community institutions
  (schools, community clinics, churches, youth
  clubs) to help re-establish normal routines and
  work with highly distressed users

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Community interventionsPsychosocial services

• Advising community authorities on the mental
  health issues
• Networking with providers in communities with
  similar experiences
• Develop and put in place evaluation procedures
  that will demonstrate the effectiveness and
  accountability of services

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• Psychiatric medication
• Treatment of dysfunctional
• traumatized clients
• Individual, family, group
  counseling
• Loss, grief and worry work
• Psychological
  evaluation and referral
• Social and life skills
  building groups
• Self help and
  mutual support groups
• Emotional support
  provisions by trained para-professionals
• Guidance in structuring
  free time
• Networking (e.g.
  youth, elderly, special needs groups)
• Family reunification
• Training of care-providers and
  dissemination of skills and knowledge
• Public awareness of normal
  psychological reactions to abnormal situations
• Information on accessing other services,
  about legal status, missing ones
• Facilitating basic social structures,
  institutions, roles and responsibilities

Level of service expertise
Number of clients served / allocation of
resources Pyramid of community psychosocial
intervention (Ajdukovic, 1997 Ajdukovic
Ajdukovic, 2003)
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Community interventionsDeveloping local
psychosocial service capacities

• Training local care-providers to increasingly
  take over responsibilities for psychosocial
  services
• This is the key to ensuring sustainable community
  services that will be needed years after a
  disaster ? outside assistance is always time
  limited

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Staff-related issues

• Because of high workload, difficult working
  conditions and a large number of distressed
  individuals, the psychosocial staff is exposed to
  high levels of professional stress and vicarious
  traumatization
• Procedures should be provided that help prevent
  burnout, regular supervision, consultation with
  peers and outside consultants, opportunity for
  professional growth and facilitating supportive
  team spirit

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Consider the time

• Community interventions in the aftermath of a
  disaster need time to yield results
• The affected population is highly distressed and
  typically impatient to see improvement in own
  mental health and well-being as well as the
  community rebuilding
• Those involved in providing community
  interventions have to deal with two conflicting
  qualities work hurriedly and be patient