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Jacobs Intervention

Jacobs Intervention

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Published by MRCMentalHealth
The Development and Maturation of Humanitarian Psychology. Submitted by Dr. Shultz.
The Development and Maturation of Humanitarian Psychology. Submitted by Dr. Shultz.

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Published by: MRCMentalHealth on Oct 07, 2009
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Simons, J. S., Gaher, R. M., Jacobs, G. A., Meyer, D., &Johnson-Jimenez, E. (2005). Associations between alcoholuse and PTSD symptoms among Red Cross disaster relief workers responding to the 9/11/2001 attacks.
American Journal of Drug and Alcohol Abuse
,
31
, 285–304.
The Development and Maturation of Humanitarian Psychology
Gerard A. JacobsUniversity of South Dakota
 Humanitarian psychological support as an organized field is relatively young. Pioneers in the field were involved  primarily in providing psychological support to refugeesand internally displaced persons in conflict and nonconflict situations. This article describes basic principles for thedesign of psychological support programs and interventions. The International Federation of Red Crossand Red Crescent Societies (IFRC) began a psychologicalsupport program in 1991. The IFRC chose psychological first aid as its model for implementation in developingcountries. Psychological first aid fits all the principles for  psychological support program design and is adapted toindividual communities. The first generation of  psychological support programs differed dramaticallydepending on the countries in which they were developed. A second generation of psychological support programsevolved in response to the earthquake/tsunami of December 26, 2004. The Inter-Agency Standing Committeeinternational guidelines consolidated the advances of second-generation programs and provided a clear indication of the wide acceptance of the importance of  psychological support. A glimpse is provided of the third generation of psychological support programs, and anadmonition is made for a more empirical evaluation of theeffectiveness of interventions.
Keywords:
disaster mental health, humanitarian assistance,international psychology, psychological support, psycholog-ical first aid
The Flight 232 aviation disaster in Sioux City, Iowa, onJuly 19, 1989, was the first of a series of events that led tothe development of a national plan for disaster mentalhealth services (Jacobs, 1995). As a result of our work inthat disaster relief operation, Randy Quevillon and I pro-posed to both the American Psychological Association(APA) and the American Red Cross the development of anational plan for providing psychological support in theaftermath of disasters. Similar ideas were fielded fromother psychologists in the months that followed as a conse-quence of Hurricane Hugo in the Southeast United Statesand the Loma Prieta earthquake in Northern California.After two years of preparation, APA and the Red Crossannounced in October 1991 that they had reached an agree-ment to have APA support the Red Cross in routinely pro-viding psychological support in disaster relief operationsboth for those directly affected by the event and for thehumanitarian relief workers who respond.In 1992, I visited the International Red Cross and RedCrescent Museum in Geneva. I was very impressed withthe Wall of Time, a display listing each of the disastersand conflicts that had resulted in more than 1,000 deathssince the founding of the Red Cross in 1859, all of whichwere arrayed around the circular outer wall of the museum.It was striking that out of the many hundreds of eventschronicled on the wall, only a few had occurred in theUnited States. It became clear to me that as disaster psy-chology developed, it would need to look beyond the bor-ders of the United States to include an international hu-manitarian perspective and to serve a much broader worldaudience.Essentially, the term
psychological support 
refers tostrategies for helping meet the psychological needs of ordi-nary people who have experienced extraordinary events. Itfocuses on helping people deal with the emotional, cogni-tive, physiological, and behavioral reactions to traumaticevents. Traditional mental health services, in contrast, fo-cus on responding to psychopathology or on long-termself-improvement. Over the past 15 years, concepts of psy-chological support have evolved and matured. Terminologyin the field can still be somewhat confusing, and terms areoften used with contradicting definitions. In many cases,however, psychological support has been categorized into(a) disaster mental health or disaster psychology, whichinvolves services provided by mental health professionals,and (b) psychological first aid, which involves support pro-vided by family, friends, and neighbors but not by mentalhealth professionals (Jacobs & Meyer, 2005).I have served as an American Red Cross Disaster Ser-vices volunteer since the crash of Flight 232. I was one of Editor’s Note
Gerard A. Jacobs received the International Humanitarian Award. Award winners are invited to deliver an award ad-dress at the APA’s annual convention. A version of thisaward address was delivered at the 115th annual meeting,held August 17–20, 2007, in San Francisco, California. Articles based on award addresses are reviewed, but theydiffer from unsolicited articles in that they are expressionsof the winners’ reflections on their work and their views of the field.
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American Psychologist
 
two psychologists who represented both APA and theAmerican Red Cross on the committee that developed theDisaster Mental Health Services model, providing com-mentary from South Dakota on each generation of propos-als. I served for eight years as a national consultant forDisaster Mental Health Services in the American RedCross and as one of the initial members of the APA Advi-sory Board for the Disaster Response Network, APA’s na-tional network of disaster response volunteers. Within myfirst few years in those various roles, I met a number of Red Cross paid or volunteer staff who had served as inter-national humanitarian delegates with the American RedCross, the International Federation of Red Cross and RedCrescent Societies (IFRC; the part of the Red Cross move-ment that deals with nonconflict situations), or the Interna-tional Committee of the Red Cross (the part of the RedCross movement that deals with conflict and acts of war).The delegates told harrowing tales of their experiencesserving refugees and internally displaced persons in conflictand nonconflict situations. I was surprised to learn thatthese delegates had not been offered any assistance in cop-ing with the experiences they had directly experienced,with the scenes they had witnessed, with re-entering theircomparatively plush Western lives after working formonths or even years in portions of the world experiencingintense hardship, or with rejoining a family constellationthat had continued to grow and develop despite the dele-gate’s absence.In 1994, I began to advocate for better care for interna-tional humanitarian workers within the IFRC. In 1991, theIFRC had begun to explore the idea of developing a world-wide Psychological Support Program. I wanted to ensurethat the IFRC was considering the needs of the interna-tional humanitarian delegates, not simply the needs of those directly affected. I had an emerging vision even thenof developing psychological support programs that couldimprove the resilience and coping capacity of peoplethroughout the world, in different continents, cultures, andcircumstances. However, I felt that the first step was totake care of the humanitarian relief workers who were vol-untarily putting themselves on the front lines to try toserve those in need. I did not see myself participating inthe development of those models, but rather saw myself encouraging the experts in the field to move in that direc-tion.I don’t think I could have imagined then the way mycareer would develop. To my dismay, I learned that therewere relatively few experts in the field at that time. Manyof these early pioneers had made their marks in relatedfields and routinely put themselves at significant risk forthe sake of serving those in need. They were and continueto be an inspiration to me.
Pioneers: The Care of Refugees and InternallyDisplaced Persons
Mary Petevi had worked for years within the Office of theUnited Nations High Commissioner for Refugees and theWorld Health Organization. (She recently retired aftermore than 30 years in the field.) Much of her time wasspent in the field in difficult circumstances, trying to pro-tect and support those affected by conflict and disaster. Herfocus on the protection of refugees and internally displacedpersons included an understanding of the psychological andsocial impact of being a refugee and an understanding of the need for basic psychological and psychosocial support.She also understood the problems of applying Western de-veloped-nation concepts of diagnoses, treatment, and psy-chopharmacology to persons in severe distress in develop-ing countries. She brought to this work her own experienceof being a refugee since 1974. She empowered local pro-fessionals, associations, and the refugees and displaced per-sons themselves in the development of policies and prac-tices. She supported their efforts toward improvedindividual and collective psychosocial functioning and re-covery. She spearheaded the development of the WorldHealth Organization’s
Tool for the Rapid Assessment of  Mental Health Needs of Refugees, Displaced and Other Populations Affected by Conflict and Post-Conflict Situa-tions: A Community-Oriented Assessment 
(Jacobs, Revel,Reyes, & Quevillon, 2006; Petevi, Revel, & Jacobs, 2001),and their
Declaration of Cooperation: Mental Health of  Refugees, Displaced, and Other Populations Affected byConflict and Post-Conflict Situations
(Petevi, 2001).Jean-Pierre Revel had served for many years as a physi-cian field delegate with various nongovernmental organiza-tions before joining the IFRC. He assisted those who foundthemselves in some of the most difficult circumstances andlocations in the world. He was chosen to be the first coor-dinator of the IFRC Psychological Support Program. Al-though not a mental health professional, he had a sense,firmly rooted in years of fieldwork, of the need for effec-tive basic psychological support. He developed a modelthat explained that individuals affected by traumatic eventswere most likely to seek psychological support from theirfriends and family, and he suggested that the communitywas the best level for intervention (International Federationof Red Cross and Red Crescent Societies, 1998).Michael Wessells has spent much of his career protect-ing children and families in conflict and postconflict situa-tions, working both with the Christian Children’s Fund andas a professor teaching a new generation about these is-sues. He received an APA Presidential Citation for his hu-manitarian work at the annual APA convention in Hawaiiin 2004. His development of effective community-basedmodels and his development of theory have touched count-
933November 2007
American Psychologist
 
less lives (e.g., Wessells, 1998, 2006; Wessells & Mon-teiro, 2004).Jon Hubbard has served for many years as a psychother-apist and field-based researcher for the Center for Victimsof Torture in Minneapolis. He has served in many conflictsituations. Among other psychosocial projects, Hubbardhas worked to develop culturally appropriate community-based research models that can be implemented quickly indiverse communities (e.g., Hubbard & Miller, 2004). Hecontinues to remind psychologists that even in complexcrisis situations, intervention decisions are best based onvalid empirical data and on program evaluation that is sup-ported by and actively involves the target communitiesthemselves. He is part of the Center for Victims of Tortureteam that received the APA International HumanitarianAward in 2006 (Stepakoff et al., 2006).
Foundation Principles in Humanitarian PsychologicalSupport
In participating in the development of models for interna-tional disaster psychology and psychological support, Iconsulted with colleagues in community psychology, com-munity theory, and cognitive–behavioral psychology. I ex-pected to find dramatic differences in the ways differentcultures experience traumatic stress, but as I worked inmore and more countries and on various continents, I wasstruck much more by the similarities of traumatic stressreactions than by the differences. Spielberger (1966) pre-sented a model of individual reactions to stress. Althoughthe key to his model was the individual’s cognitive ap-praisal of the stressor, he also suggested that individualshave a limited supply of coping resources, and once thoseresources are expended, the individual will experience astress reaction. Hobfoll (1989) has extensively elaboratedthese concepts in his conservation of resources theory.I have come to define traumatic stress as stress that is of such magnitude that it can overwhelm anyone’s copingresources, no matter how strong they are, how well-pre-pared, or how extensive their coping skills. I have devel-oped a hypothesis over the years that it is the overwhelm-ing nature of the stress that leads to the similarity of reactions in such disparate cultures. Nevertheless, withSpielberger as a mentor, I was strongly aware of the im-portance of culture in helping people prepare for and re-spond to stress in their lives (see, e.g., Spielberger & Diaz-Guerrero, 1976). That is, culture in all its aspects has thepotential to influence both resilience and the ability to re-cover from traumatic stress—to affect them positively ornegatively.The seven basic principles that I teach for designing anappropriate psychological support program have essentiallybeen the same from the beginning, but my understandingof those principles has matured over time. First, do noharm. That cautionary statement is not merely a trite tru-ism. Anderson (1999) cautioned those involved in humani-tarian assistance to think about these issues in depth, toexplore the possible hidden ways that well-intentioned ef-forts may produce significant harm. Beware of those whoadvocate that something is better than nothing and whowish to forge ahead with interventions that have not beenwell planned and prepared with the local community. Thepotential for harm is real. It is sobering to realize that insome cultural settings, psychologists may put an individu-al’s life at risk even by talking to them without appropriatepermissions. This dramatically underlines the importance of Principles 2 and 5 described here. The first principle alsospeaks to the importance of incorporating effective assess-ment, monitoring, and evaluation in psychological supportprograms, to ensure that humanitarian interventions do nothave iatrogenic effects. Second, programs need to be com-munity based. My work in India gave me a new perspec-tive on this principle. In India, the concept of communityis used to refer to groups of people who share a commoninterest rather than to a geographically determined group.Thus, a single town or village can have multiple communi-ties, grouped by religion, ethnicity, socioeconomic status,politics, or any number of other possibilities. Therefore, tobe truly community based, a program needs to be adaptedfor each interest group, to build on their strengths and meettheir needs in a culturally responsive manner. This virtuallynecessitates the involvement of the community itself in thedesign and implementation of the program (see Principle5). Third, programs need to be sustainable. They must becapable of being maintained (e.g., affordable), but they alsomust have sufficiently obvious merit to engage communi-ties in maintaining them. Fourth, programs need to buildon the strengths of the community being served. Every cul-ture has unique practices and coping strategies that can beintegrated into the program and that build the sense of ownership of the program in the community. Fifth, uselocal expertise. This is in part related to both Principles 1and 2. Local residents will be there to serve the communityfor the long term and can help to design a program that istruly appropriate for that specific community. Sixth, pro-grams need to primarily address ordinary reactions to ex-traordinary events. Psychological support is focused onhelping people through particularly difficult events in life,not on addressing traditional psychopathology. This focushelps psychological support bypass some of the culturalroadblocks that may exist in the conceptualization of psy-chopathology. Seventh, the final principle is one that is notuniversally endorsed in the field. I suggest that every resi-dent of the affected area needs to be offered psychologicalsupport. Some colleagues prefer models that serve only acertain percentage of the target population, suggesting thatthey are more realistic. I do not think it is profitable to setminimalist goals when there are viable program models,such as psychological first aid, that can serve all those in
934 November 2007
American Psychologist

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