A M E R I C A N R E D C R O S S Psychosocial Support Programs Background: While the American Red Cross has been implementing domestic disaster mental health services since the 1970s, its commitment to international psychosocial work is a more recent development. Earthquakes in El Salvador and in the Indian state of Gujarat in 2001 brought to light the critical need for psychosocial care and support to alleviate human suffering in the aftermath of large-scale disasters. The massive devastation caused by the Gujarat earthquake in particular galvanized the American Red Cross, and the generous donations of the American people helped support the first comprehensive international psychosocial program in our organization s history. Since its inception in 2001, the American Red Cross model of psychosocial support programs has evolved with an emphasis on embedding psychosocial care in our international emergency response systems, strengthening our commitment to Gujarat Earthquake Statistics Killed: 20,000 + Injured: 167,000 + Homes Destroyed: 1 Million + Affected Population: ~ 15.9 Million provide relevant psychosocial programming, and enhancing our capacity to respond to large-scale disasters As a result, when the Indian Ocean Tsunami occurred on December 26 th, 2004, the American Red Cross was able to deploy a rapid psychosocial response to the affected region. Overview: The American Red Cross psychosocial support programs target individuals and communities in disaster-affected regions. It is important to note that, unlike some other international humanitarian assistance organizations, the American Red Cross does not seek to provide direct counseling or therapy services to those affected by disasters. Rather, our programs employ participatory community development and community mobilization techniques to improve psychological and social functioning while, at the same time, enhancing psychosocial resilience in order to mitigate the impact of future disasters. The American Red Cross psychosocial support program provides financial and technical assistance to the lead implementing agencies our Partner National Societies. Activities conducted are, for the most part, carried out with groups of people and the impact of these interventions is assessed at both an individual and group level. Broadly speaking, American Red Cross psychosocial program activities fall into three categories: 1) community-based interventions, 2) school-based interventions, and 3) capacity-building interventions. These interventions are supported by material-development and documentation services that assist the organization to both reach beneficiaries with targeted culturally and linguistically appropriate messaging and to derive lessons-learned to enhance future program implementation in the psychosocial sector. Program Model SPHERE Community- Based Interventions Capacity- Building Interventions INEE Standards IASC Guidelines School- Based Interventions Currently, the American Red Cross is facilitating the implementation of psychosocial support programs in four countries: Sri Lanka, the Republic of Maldives, Indonesia, and India. Most of our current programs are related to the 2004 Tsunami but our psychosocial portfolio in India continues to support long-term recovery operations in Gujarat. One of the many challenges that we face as an organization is to maintain programmatic consistency while retaining sufficient flexibility to meet the diverse needs of different cultures and ethnic groups affected by disasters. Consequently, program implementation is tailored to address country-specific needs and contexts, but the general theory and design of our psychosocial interventions remain grounded in a common theoretical and programmatic approach. To ensure high-quality and consistent psychosocial programming, the American Red Cross is committed to implementing programs in accordance with internationally recognized standards. The most important of these include: 1) the SPHERE project standards, 2) the Interagency Network for Education in Emergencies (INEE) standards, and 3) the recently released Inter-Agency Standing Committee (IASC) Guidelines for Mental Health and Psychosocial Support in Emergencies.
Community-Based Interventions: Community-based interventions are the mainstay of the American Red Cross psychosocial support program and address a number of program objectives. As noted above, basic community development techniques are employed to achieve psychosocial benefits through the development and promotion of resiliency in communities and individuals. Here, resiliency is defined as the ability to recover or bounce back from adverse life events such as disasters and is related to the larger construct of psychosocial well-being in the sense that those who are better equipped to respond or react to a disaster are less likely to experience the negative psychological effects of trauma exposure. The American Red Cross psychosocial support program also engages in other activities to support psychosocial recovery at the community level. The desired impact of these additional interventions are less dependent on community mobilization techniques, but all are planned using participatory methodologies and encourage communities to take ownership of their own recovery. Specific community-based psychosocial support activities in the American Red Cross repertoire include: 1) resilience-building activities and projects, 2) sense-of-place activities, and 3) informal health and schooling activities. Resilience-Building Activities & Projects The American Red Cross psychosocial support program works with communities to facilitate activities that encourage individuals to come together to identify, plan, and meet the needs of their community. These activities promote social cohesion and communal problem-solving. Although the process is quite involved and is implemented differently in each community, the basic structure of these interventions remains reasonably constant. The work begins with the introduction of the psychosocial support team to the community and the establishment of rapport with community leaders and members. A careful assessment of communities needs and resources (frequently involving the creation of a community map) is conducted by the community itself and the psychosocial support team facilitates a planning exercise that prioritizes needs and mobilizes the community to work together to resume activities or restore social systems that existed prior to the disaster. The focus during this planning is to identify resources available within the community itself that could be utilized to meet the identified needs. The American Red Cross psychosocial support program provides financial assistance only to provide resources that the community cannot provide for itself. Importantly, emphasis is not placed on the final product of these activities, but rather on the planning and implementation process that strengthens relationships between community members, provides opportunities for individuals to share their experiences, empowers community members, and facilitates communal problem solving. Examples of community resilience-building activities carried out by the American Red Cross psychosocial support program include: 1) community center refurbishment, 2) the creation of craft groups, and 3) organizing sporting events. Sense-of-Place Activities Sense-of-place is traditionally defined as an individual s personal relationship with his or her physical surroundings. The American Red Cross psychosocial support program expands upon this definition to include individuals relationships or sense of connection with their culture, traditions, and history. These activities are particularly meaningful given the impact that large-scale disasters have on the physical environment and the ability of communities to engage in traditional cultural events. Like resilience-building activities, senseof-place activities are the product of a careful planning process that involves community members in every stage of activity development. Unlike resilience-building activities where the final product is less important than the process, however, equal weight is given to both the process and the product of sense-ofplace activities. The final outcome of these activities is meant to restore individuals connection with their physical environment and/or their cultural heritage. Specific examples of sense-of-place activities include: 1) community tree-planting projects, 2) support of culturally appropriate grieving rituals and memorial services, and 3) facilitation of cultural events such as traditional dance or community theater. 2
Informal Health & Schooling Activities As part of our informal health interventions, the American Red Cross psychosocial support program provides training in psychological first aid and self-care to community members and traditional healers. Psychological first aid training prepares individuals to provide sub-clinical psychological support services to disaster survivors. It is a proven intervention and is widely used throughout the industry. While psychological first aid may be useful in addressing the lingering effects of trauma exposure, it is primarily intended to equip members of the community to care for others in the immediate aftermath of future disasters. Selfcare training is designed to offset the effects of burn-out or compassion fatigue and to enable community responders to meet their own psychological needs as well as those of others. Together, these training initiatives are intended to create and support a cadre of paraprofessionals who can mount a psychosocial response immediately and more effectively in the face of subsequent disasters. Informal schooling activities provide for the basic educational needs of young children in environments where the formal education system has not yet been restored. The American Red Cross model seeks to involve older members of the community in providing educational services and also provides parents with an opportunity to meet and socialize or attend to other needs, secure in the knowledge that their children are being cared for in a safe and productive environment. School-Based Interventions: Because children, as a group, may be particularly vulnerable to the psychosocial impacts of disasters, spend significant portions of their time in schools, and because schools are often the first social institutions rebuilt, the American Red Cross psychosocial support program supplements its community-based interventions with activities designed for and with schools. Doing so enhances the program s ability to reach a critical group of beneficiaries and, more importantly, provides an opportunity to capitalize on existing resources available to communities. The school-based interventions of the American Red Cross psychosocial support program share many elements in common with the community-based interventions discussed above. Both resiliencebuilding and sense-of-place activities, for example, are used in schools to achieve similar effects as in communities. The portfolio of school-based interventions, however, also includes creative and expressive activities and crisis response planning in its efforts to assist children and teachers to recover. Resilience-Building & Sense-of-Place Activities As with communitybased activities of these types, the purpose of school-based resilience-building and sense-of-place activities is to bring people together to work collectively towards their own recovery. In schools, the American Red Cross psychosocial support program works with students and teachers to help develop projects that will encourage communal problem-solving to address issues that face the school community and that reinforce students connections with the school environment, their traditions, and culture. Children are involved in all stages of activity planning and execution. Furthermore, activities are identified on the basis of participatory assessment methods that are designed to elicit input from school-age children. Teachers and school administrators are included in the planning and implementation process as fellow members of the school community and their opinions and ideas are given equal weight as those offered by students. The financial support that is provided to schools to support these activities is meant to secure resources that the school is unable to provide for itself. Here, it is important to remember that the purpose of school-based resilience-building and sense-of-place activities is not merely to provide goods or assistance, but to facilitate program beneficiaries to make decisions about and take responsibility for their own recovery. Specific examples of such activities include: 1) hosting parent-child activity days, 2) campus beautification projects, 3) supporting traditional dance or music educational activities, and 4) school equipment refurbishment. 3
Creative & Expressive Activities Children are effected by and recover from disasters differently than adults. Notably, children may experience neurophysiological changes and developmental delays or set-backs as a consequence of trauma exposure. Furthermore, younger children have not yet developed language and cognitive skills necessary for the identification, expression, and processing of their emotions. The American Red Cross psychosocial support programs seek to address these special needs, in part, through creative and expressive activities. These activities help restore fine-motor coordination skills, provide opportunities for children to express themselves in non-verbal ways, and help children to socialize more appropriately with their peers and caretakers in the aftermath of disasters. In all cases, special emphasis is placed on tailoring activities to the appropriate age-level to ensure that they are enjoyable and engaging. Psychosocial support program staff work with school teachers and administrators to provide training in child development and project design and implementation so that teachers can develop activities that maximize psychosocial benefit. Financial support is provided to purchase materials necessary for these activities. Specific examples of creative and expressive activities commonly implemented in the American Red Cross psychosocial support program include: 1) drawing and painting, 2) sewing, and 3) other arts and crafts activities. Crisis Response Planning The American Red Cross psychosocial support program seeks to prepare schools to be better able to respond or react to future disasters and crises. This category of school-based interventions shares many elements in common with traditional disaster-preparedness interventions but important differences remain. The purpose of crisis response planning in the psychosocial support model is not merely to improve the safety of the school environment, but also to build resilience and protective factors within the school community so that, when subsequent crises occur, children are less likely to experience psychological distress as a consequence. As with resilience-building activities, the psychosocial benefits of crisis response planning in schools comes from the collaborative and participatory processes through which the response systems are developed and implemented. Children and school officials are the architects of each school s crisis response planning activities. Children, faculty, and staff are organized in teams, each of which serves a specific function (psychological first aid, physical first aid, assessment, evacuation, and coordination) in preparing for and responding to disasters. These teams identify threats and design and implement corrective actions. They develop contingency plans and execute preparedness drills that provide members of the school community with realistic experience responding to potential crises. Specific activities include: 1) mapping of the school environment to identify risks and resources, 2) development and dissemination of accurate response information in accessible formats, 3) administration of disaster response drills that provide experience and help identify problems in response plans, and 4) providing training (e.g., psychological first aid and self-care) to students and teachers to assist in disaster response. Capacity-Building Interventions: In addition to conducting community-based and school-based interventions, the American Red Cross psychosocial support programs engage in activities to build the capacity of our partner national societies, host national governments, and disastereffected populations to respond more effectively in meeting the psychosocial needs that will arise from future disasters. The principle vehicle for these capacity building efforts is training in a variety of forms targeting a broad range of individuals. From the most rudimentary training level to the most complex, the goal of these activities is to provide practical guidance on how to provide psychosocial support interventions to beneficiaries and how to design more programmatic psychosocial response mechanisms. Ultimately, the training programs included in the American Red Cross psychosocial support model are meant to develop the infrastructure necessary to support independent, sustainable, and culturally appropriate psychosocial programming in the countries where we work. Below, a number of the specific training interventions carried out as part of the American Red Cross psychosocial support program are discussed in greater detail. Included in all of the American Red Cross psychosocial support program training efforts are two technical areas that warrant a more general discussion, however. These are psychological first aid and psychoso- 4
cial self-care trainings. Embedded in each of the trainings that the psychosocial program conducts, these topics are meant to provide participants with the skills necessary to assist survivors cope with the emotional and psychological effects of disasters in their immediate aftermath (psychological first aid) while at the same time caring for their own needs as disaster responders (self-care). Together, these training components contribute to the creation of a cadre of trained paraprofessionals who can assist in mounting a psychosocial response and who can act to protect themselves from the effects of burn-out or compassion fatigue. Some of the specific capacity building interventions that incorporate these themes include: 1) operational volunteer training, 2) the Crisis Intervention training series, and 3) pre-service teacher training. Operational Volunteer Training The American Red Cross supports international psychosocial programming by training local residents to provide services and implement programs rather than sending large numbers of trained professionals to disaster-effected areas. Consequently, when the American Red Cross psychosocial support programs begin working in a country, one of the first tasks is to recruit and train volunteers to carry out programming. This model promotes sustainability and encourages capacity building of our partner national societies as trained volunteers will continue to serve as resources for future locally initiated psychosocial interventions. In addition to training in psychological first aid and self-care (mentioned above), operational volunteer training is designed to prepare participants to conduct psychosocial needs assessments, enter communities and establish relationships with key leaders, and to assist communities and schools in identifying resources already available to them. Where appropriate, orientation and induction to the Red Cross/Red Crescent movement are also included in the syllabus. In the immediate response phase, a large number of volunteers are needed to conduct assessments and meet the immediate psychosocial needs of a disaster-effected population. It is expected that many individuals who receive operational training will not be available for long-term recovery efforts. Those individuals who show particular interest in and aptitude for psychosocial programming may be invited to participate in the Crisis Intervention training series. The Crisis Intervention Training Series The American Red Cross psychosocial support program has developed a series of training courses collectively referred to as the crisis intervention training series. This graduated series of courses provides training in increasingly advanced theories and techniques of psychosocial practice. Here, the training goal is not merely to produce graduates who can implement psychosocial interventions designed by others, but rather to develop the skills necessary to lead implementation teams, design psychosocial programs independently, adjust programs as problems arise, and provide technical supervision to volunteers, and provide technical advice to national societies and/or government institutions. The crisis intervention training series includes three courses: 1) Crisis Intervention Technician Training, 2) Crisis Intervention Specialist Training, and 3) Crisis Intervention Professional Training. The last, crisis intervention professional training is the culmination of the training series and is meant to be implemented in partnership with a local university or national-level training institution to produce masters-level professionals who can not only design and implement culturally appropriate psychosocial interventions, but can make meaningful contributions to the professional and academic body of knowledge around psychosocial programming issues. In return for participation in these trainings, the American Red Cross psychosocial support program requires that participants provide a set number of hours of service within the psychosocial sector. These practicum hours not only cement learning from coursework, but also provide host national societies or governments with a ready human resource pool with identified and standardized training in psychosocial programming. Pre-Service Teacher Training Finally, wherever possible, the American Red Cross psychosocial support programs work directly with our partner national societies and host governments to insert standardized psychosocial syllabi into the curricula of teacher-training colleges. By doing so, we guarantee that a critical resource for recovery within communities and schools (i.e., teachers) are prepared with the requisite psychosocial knowledge to respond to disasters when they occur. Even more important, however, is the concept that by educating pre-service teachers on the psychosocial consequences of crises and disasters they will be able to prepare lessons and foster environments that promote psychological resilience in children. 5