INDIAN RED CROSS SOCIETY 1 Red Cross Road New Delhi, India 10011

DISASTER MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT: THE TRAINING MODEL1 Dr. Joseph O. Prewitt Díaz2 One of the objectives of the American Red Cross strategy in providing technical and financial support to the Indian Red Cross Society is to conduct staff development activities in all sectors of the Society: National HQ, State Branches, and Local Branches. In the target local Branches, villages and schools will be targeted for direct services. Teachers and community facilitators will be trained via thematic units focusing on group development, community based disaster mental health preparation, publicizing mental health and psychosocial care programs, and skills necessary to promote proactive behaviors. To achieve the training objective of the Workplan, three distinct groups will be prepared: (1) crisis intervention professionals, (2) crisis intervention specialists, and (3) crisis intervention technicians. Crisis Intervention Professionals The first group, crisis intervention professionals, is individuals who have a background in mental health or disaster preparedness, response, or management. They will be assigned to the Disaster Management Center (DMC) of the Indian Red Cross Society, and will commit 500 hours of volunteer time after completing the program of study. The pre-requisite to participate in this program is a Master·s degree or higher and/or equivalent experience in disaster related activities. The role of the professionals will be to:

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This model was adapted from the Disaster Mental Health and Psyhcosocial Support developed by the author in Guatemala, CA. 2 Dr. Prewitt Diaz served as the Head of Programs for India on behalf of the American Red Cross 20022008.

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1. Advice the DMC staff on matters of Disaster Mental Health before, during and after a disaster. 2. To conduct or coordinate the development and execution of a rapid needs assessment in the affected geographical area. 3. To call out other mental health professionals, organize DMH teams and coordinate teams in the field from the DMC to provide timely service to the affected geographical area. 4. Prepare, conduct, and disseminate training activities, education, and public information activities pertaining to Disaster Mental Health. 5. Coordinate DMH services to the affected community with GO·s and NGO·s. 6. Other activities as assigned by the DMC Director. To perform these tasks, the candidate will complete a course of study composed of eight (8) courses. These courses will require (1) classroom activities, (2) small group activities, and (3) a fieldwork activity. To complete the course a final project will be conducted by each candidate under the supervision of a faculty member and prior approval from the IRCS. The following are the suggested courses: 1. Introduction to the Red Cross movement. (16 hours). The ICRC, the IFRC, and the IRCS. The Geneva Convention, the Seville Agreement and other pertinent information regarding the movement. The SPHERE Indicators and the WHO guidelines for psychological care will be discussed. It is expected that the candidate will have the basic knowledge required by a Red Cross volunteer and will be able to be inducted as a volunteer into the IRCS. Disaster Preparedness and Response. (45 hours) This course introduces crisis intervention professionals to decisions and actions required at the disaster site by local, state, and NHQ involved in disaster relief and reconstruction. This module is designed to increase the audiences· awareness of the nature and management of disasters, leading to better performance in disaster preparedness and response. By understanding the crisis intervention professional role, we can describe a coherent and cohesive direction for people who are involved in the field of crisis intervention during disaster.

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Rehabilitation to Reconstruction: From Disaster Mental Health to Psychological Care. (45 hours). The training module illustrates the key principles and strategies for effective rehabilitation and reconstruction after a disaster. It highlights the constraints and opportunities provided by these stages of recovery from impact of damaging events. It provides the crisis intervention professional will understand the linkages between the various stages of the psychological response in each of the phases within the disaster continuum. Management of Disaster Mental Health/Psychosocial care in the DMC and the target geographical area. (45 hours). This course will introduce the concept of disaster management to the crisis intervention professionals. The training process is designed to increase the awareness of the nature and management of mental health and psychosocial health care during a disaster. The participant will understand the nature and procedures of administrative crisis intervention in the wake of disasters involving several specific operations, such as: communicating with other health and social services, coordinating, planning, monitoring and effective delivery of mental health and psychosocial care to several affected sites at the same time. Principles of Disaster Mental Health and psychosocial care. (45 hours). Mental Health services have a vital role to play in the coordinated response to disaster in the community. A considerable body of scientific research is now available to guide the formulation the appropriate mental health and psychosocial care responses and help in the identification of those who may require on-going support. This course is designed to explore the existent body of scientific research and to identify principles that are applicable to India. Physiology, psychology, and management of Stress. (45 hours). This course is designed to teach techniques that prevent and mitigate the psychological dysfunction which exposure to traumatic situation like disasters may cause in the survivors and first responders. It seeks to develop strategies that will provide persons with the knowledge and skills to

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better understand, recognize, and manage their emotional responses to traumatic situations. 7. Stress mitigation in the schools and communities (45 hours). The learner will comprehend the four strategies for stress mitigation in schools and communities: training of indigenous personnel and teachers, disaster preparedness and strategies for stress management, how to utilize media to deliver messages related to stress management, and care activities in the community. The method to provide teachers and other school personnel with techniques that will assist in the promotion, organization, development and evaluation of stress mitigation plans in educational centers. Crisis, crisis intervention and psychological first aid (45 hours). The course will begin with a discussion of the three forms of prevention (reduce the incidence of disorders; minimize the harmful effects of events that have already occurred, repair damage long after its original onset). Secondly, the course will help the learner to name the basic strategies in crisis intervention: enhancement and treatment strategies. Thirdly, the learner will learn to re-establish immediate coping by utilizing strategies of psychological first aid.

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At the conclusion of the course of study and the completion of the 500 volunteer hours of service, the candidate will receive a Certificate as a Crisis Intervention Professional.

Crisis Intervention Specialists The crisis intervention specialist will be prepared at the State level. In each target State there will be about 35 specialists trained. These individuals will be assigned to the State Branch of the IRCS and will commit three (300) hours of service. In the preparedness phase, the specialist will provide education about stress mitigation to the schools and community. During a disaster they will be responsible for the organization of the immediate response teams. They will coordinate immediate crisis intervention and psychological first aid activities to the survivors and emotional support activities for the first responders. The pre-requisite for participation in this program is an advanced

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degree in education or social work and/or experience in disaster preparedness and response. The role of the crisis intervention specialist will be to: 1. 2. 3. 4. 5. 6. 7. Advice the State Branch staff on matters pertaining to disaster mental health and psychosocial care. Generate a list of mental health professionals and volunteers in the community and develop a call-out system. Provide disaster mental health and psychosocial care education to the Technicians in the Branch level, teachers, aanganwadi workers, and village members. Generate a vulnerability map of all the target villages, in conjunction with local Branches, participating communities and schools. Responsible for quarterly simulations of DMH/PC response in the target villages and schools. Develop knowledge of instructional methodology appropriate to adults in the local Branches and the target villages. Provide technical assistance in development public relations activities that highlight mental health for the communities and villages.

To perform these tasks the candidate will complete a 15-day program of study consisting of five modules: 1. The ICRC, IFRC, and the IRCS. a. The Fundamental Principles b. The Seville Accord c. WHO standards of response d. SPHERE minimum indicators of service. 2. Elements of community development. a. Importance of community development in stress mitigation b. Situational leadership c. Communication skills. d. Verbal and non-verbal behavior 3. Disaster preparedness, response and disaster mental health/psychosocial care. a. Disaster preparedness and response b. Diagnosing the community strengths and needs through mapping

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c. Triage and Rapid Needs Assessment (WHO Rapid Assessment of Mental health needs; WHO Mental health check list of frequent complaints in emergencies; Composite International Diagnostic Interview) 4. Promoting disaster mental health and psychosocial care in the villages and schools. a. Fundamentals of Instruction to support and implement the DMH/PC program in schools and villages. b. Developing community awareness campaigns c. Approaching the press (print, TV, radio). 5. Stress mitigation in the community and schools a. Psychological first aid b. Crisis intervention c. Stress management, relaxation exercises, and other self-care activities. d. Using community metaphors to encourage communication e. Visualization and affirmations f. Returning to emotional wellness after a disaster. At the conclusion of the course of study and the completion of the 300 volunteer hours of service, the candidate will receive a Certificate as a Crisis Intervention Specialist. Crisis Intervention Technician The crisis intervention technician will become volunteers of the local Branch of the Indian Red Cross Society. This group of individuals will be trained at the State level. This group will be responsible for developing preparedness, stress mitigation, and recovery activities in selected villages and schools. The background of the participants will be that they are local Branch IRCS volunteers, aanganwadis workers, teachers and others in the community with disaster response experience. The technicians will be expected to: 1. 2. Respond through the local Branch to provide Psychological First Aid if needed after a disaster. Conduct Rapid Needs Assessment in target villages in the event of a disaster.

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Organize preparedness, stress mitigation and response activities in the schools and villages. Review and prepare existing materials to publicize disaster mental health and psychosocial care. Encourage social networking through stress management activities in the community. Develop community resource centers with support of the Crisis Intervention Specialists.

To perform these tasks the candidate will participate in an 80-hour program of study to be completed in eight days. The program will consist of the following units: 1. Introduction to the ICRC, IFRC, and the IRCS. a. The Seville Agreement b. SPHERE indicators 2. Disaster mental health to psychosocial care 3. Psychological First Aid, crisis intervention, information, education and referral. 4. What is a Rapid Needs Assessment and how do to use the tool a. WHO Rapid Needs Assessment Tool b. WHO checklist for frequent complaints in emergencies b. ARC Rapid Needs Assessment Tool 5. The community facilitator as an agent of change a. Organizing the community b. Assessment of community needs and protective factors as they relate to disaster mental health and psychosocial care. c. Promoting Mental Health and psychosocial care thought the media. d. Mental Health preventive and care activities 6. The teacher as the Stress reduction manager in the schools. a. Assess needs and protective factors in the school as they relate to mental health and psychosocial care. b. Develop an emergency response plan that includes feasible strategies to address risk situations in the educational center. c. Organize groups composed of teachers, children, and other school personnel and parents that will design a strategy of response to a possible situation of emergency. d. Conduct simulations to test knowledge, skills and abilities of self-care, and the appropriate use of materials and

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equipment. 7. Elements in developing a community resource center that will foster community reunification and networking. The participant will receive a certificate as a Crisis Intervention Technician after completing the academic requirements, the practical experiences and 200 hours of volunteer services. In the following years there will be promotion from within the ranks so that a technician may qualify to participate in the specialist course of study, and the specialist may qualify to participate in the professional course of study.

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