Better days are ahead for tornado-affected Communities

Joseph O. Prewitt Diaz[1] PhD

It was not until I saw, smelled and heard the stories of disaster-affected people in Sri Lanka, Banda Aceh and Chalang, after the 2004 South Asia Tsunami. It was through daily exposure that understood the meaning of the phrase “root shock”[2].

As we look at the future of Joplin, Missouri and Jarell, Tuscaloosa and Birmingham in Alabama clearly these towns and its people have experienced “root shock”. The loss of the home itself may not be the only indicator of negative psychological consequences. The roots that were left exposed will certainly influence their well-being: (1) loss of property, (2) loss of income, (3) loss of job, (4) loss of family, friends, and neighborhood, (5) loss of the way of life, and (6) limited access to essential services such as health care. If this were not enough, the disaster-affected people currently in shelters are at elevated risks for reduced hygiene, exposure to communicable diseases, insufficient water, rest and malnutrition.

I have had the opportunity to provide psychosocial support in different settings in the United States and many countries around the world. The lesson learned is that when the families resettle and caring networks are built around them, they whither for a while, but emerge stronger, more resilient, and appreciate of the newfound well-being.

Time is of the essence to put places together and get the disaster-affected people into some kind of normalcy. The community structures, and local networks will have to walk the proverbial extra mile to accept and care for the disaster-affected people. One thing is for sure:  “BETTER DAYS ARE AHEAD”. Disaster affected people will re-establish their place. The root shocked families with the right kind of nutrients and nurturance will succeed. I pray that day comes soon.

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[1].  Dr. Prewitt Diaz is Visiting Professor and Director of the Disaster Law and Policy Study Center, School of Law of the University of Puerto Rico. He is the 2008 recipient of the APA International Humanitarian Award.

[2] The phrase “Root Shock” was formulated by Dr. Mindy T. Fullilove in her book “Root Shock” 2004 published by Random House. 

IS THE JOPLIN EMERGENCY OVER?

Joseph O. Prewitt Díaz[1], PhD

The news today was positive regarding Joplin, Missouri. The number of dead has stabilized at 130+, the hospital had reopened with another name, and the disaster-affected people were photographed looking through the rubble for whatever memories were left. My neighbor saw me in the afternoon and yelled from the other side of the street: “Good news today, does this mean that the Joplin emergency is over? I just smiled and walked on. I didn’t have the courage to say, “bad things are just beginning”.

I reflected about the psychosocial effect of this terrible catastrophe over time. The disaster-affected people had (1) developed a personal identity with Joplin, through the churches, schools, shopping centers, and the hospitals (2) purchased a property and through hard work, collaboration of friends and neighbors, had turned it into a home, and (3) developed social and cultural aspirations and expectations.

There are some hard times now. The tornadoes have not only destroyed the physical “place” they have attacked and broken the bonds of continuity, familiarity and attachment to the home, neighborhood and community. I heard people say: “we are homeless”, “we belong nowhere”, “live in the shelter make us feel like we are outsiders”. The personal identity, and belongingness have been broken by the loss of control over the tornadoes and the outside organizations that have come to town introducing themselves as “Hi, my name is------,  I am with -----------, and I am here to help”.

But...better days are ahead.  Important actions taken by the community today will carry you all a long way.  Establish networks with family, neighbors and community. Volunteer your time and skills to help each other. Seek practical help, and timely information. In as much as you can listen to others, share a meal and a smile. Through your neighborhood groups join clean-up, and planning activities for the future. Soon you will realize that valued experiences and mutual understanding, bonding and learning will emerge. Soon the feelings of “despair” and “impotence” will shift to a “can-do feeling”.  You all will shift from victims to victorious!

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[1]. Dr. Prewitt Diaz is a Visiting Professor and Director of the Disaster Law and Policy Studies Center, School of Law, University of Puerto Rico. He was the recipient of the 2008 APA International Humanitarian Award.

News stories on CNN inspired this note

The spiral of psychological well being after the tornado whirlwinds

Joseph O. Prewitt Diaz[1], PhD

The last two weeks I have been in an emotional Roller coaster watching Anderson Cooper and the request of the CNN team describing the effects of the tornadoes and flooding in Middle America. As a psychologist who specializes on disaster management and humanitarian assistance every word, action, and strategy displaced by the government to resolve the crisis was brought a comment from my side on how to do it better. After watching the Memorial Service in Missouri this afternoon I realized that maybe there wasn’t a clear understanding of the psychological effect of these disasters, so let me share so points related to this topic.

The psychological meaning of the disaster had do with home. Home as our place provide us with privacy, comfort and security. Home is a place for development and maintaining social relationship and lasting attachments that bring strong ties to home. It is where the children grew, where the young bride and groom came together to make a family. It is here the neighborhood group got together to watch the football game, or to play poker, or to have a prayer meeting.  The tornadoes not only destroyed the physical home but the social relationships that the home represented.

There are three points that I would like to discuss based on the comments I heard on TV. All of this comments I have heard over the last two weeks I heard in CNN.

1.     Disruption, destruction and displacement.  Disaster-affected people have reported (a) suffering devastation, (b) being heartbroken, (c) feeling that this was a traumatic experience, (d) feeling unmotivated, or  (e) having lost interest of staying here. We may decide to reconstruct elsewhere.  The life of the disaster-affected people has been disrupted. Private houses have become public and personal possessions have become public property. Everything has been destroyed: property, possessions, people’s life identities, personal histories and attachments. People report that they are outcasts in their own homes and communities. They share there fears that the may not belong in the new place. They copying the best they can but feel alienated in their community. 

2.     Reconstruction, restoration and return to the routine. One comment caught my ear: “we have spent a lifetime building our home and lovingly restoring those part that we felt had to be restored, only for it to be thrashed”. The process of reconstruction is not simple. Once the FEMA and Red Cross representative have filled out all the paperwork and the insurance companies have been notified, then is the parade of new and strange people in our lives.: (a) the insurance company, (b) loss adjusters, building contractors, and retail outlets where we can get better prices for construction materials to name a few.  As disaster-affected people begin the restoration process, they report being scared of all that was ahead of them. At least they now that the relation toward “home” has changed, they don’t quite identify with the new place, and express their worry of “being stuck here”. “What if this happens again in a year or two?” Returning to the routine is a “chore”. Disaster-affected people normal lives and costumes have been suspended. They will have to build new lives and customs, and a new place. They were all part of the “relationship” with the old home. “Where to go?” “What awaits for my family and I?” are some of the concerns.

3.     Psychological response or achieving well-being.  There are at least three areas of psychological concern: (1) personal and familial identification, (2) personal and social identification, and (3) boundary issues as represented by a perception of private and inclusive domain as opposed to “public” and exclusive domains.

I am well aware that the impact of the psychological health are more severe and longer lasting that the physical sequalae of the tornadoes and that everybody doesn’t respond in the same way to the same stressors.  Maybe it is important to begin to think publicly about the three factors mentioned above. CNN you are the leaders in communication, can you take on this challenge?

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[1] Dr. Prewitt Diaz is a Visiting Professor and Director of the Disaster Law and Policy Center, School of Law, University of Puerto Rico. He is the recipient of the 2008 APA International Humanitarian Award. 

Psychosocial support in Missouri with 100+ deaths and counting

Listening to the news and watching TV news  this days is like watching a horror movie: tornadoes, floods, conflicts and the little gal and her children trying to survive. The psychosocial consequences of a disaster of the magnitude of the Missouri tornadoes is very difficult to assess. We know that the majority of the disaster affected folks will experience transitional distress. The good news is that a majority of folks will show a number of reactions to included resilience, a desire to re-establish "place", and an improvement in their community relationships.

Hobfoll (2009) suggests that there are five essential elements that facilitate recovery: (1) a sense of safety, promoting calm, promoting a sense of collective efficacy, promoting connectedness and promoting hope (p. 223).

The first responders, emergency management, the media, and the family members can join together at this time to strengthen the safety nets, listen, and plan for a day in the future when things will be back to a semblance of what they were prior to the disaster.

Joseph O. Prewitt Diaz, PhD

SPHERE 2011 proposes specific Community Based Psychosocial Support Interventions

The new SPHERE Project 2011 has included a new section entitled “Protection Principles” (SPHERE, 2011, pp. 24-44).  The following community-based and other psychosocial support is recommended.

Positive communal coping mechanisms such as culturally appropriate burials, religious ceremonies and practices, and non-harmful cultural and social practices should be supported.

Activities for children: Where appropriate, communities should be encour­aged to organize structured, supportive educational and protective activi­ties for children through non-formal means such as child-friendly spaces. Community protection mechanisms should include self-help activities that promote psychosocial well-being.

Help organize appropriate psychosocial support for survivors of violence. Ensure that survivors have access to community social networks and self-help activities. Access to community-based social support should be complemented by access to mental healthcare.

Integrated support system: Those agencies working on psychosocial support and mental health in various sectors should collaborate to build an integrated system of support for the population (see Essential health services – mental health standard 1 on page 333).

Clinical support: Establish mechanisms for the referral of severely affected people for available clinical support.

Psychological first aid should be available to workers who have experienced or witnessed extremely distressing events (see Essential Health Services—Mental Health Standard 1, p. 335).(SPHERE 2011, p. 73 & 335). Acute anxiety after exposure to extreme stressors (e.g. traumatic events) is best managed following the principles of psychological first aid, which is often mistakenly seen as a clinical intervention. Rather, it is a description of a humane, supportive response to a fellow human being who is suffering and who may need support. It entails basic, non-intrusive pragmatic care with a focus on listening but not forcing talk, assessing needs and concerns, ensuring that basic needs are met, encouraging social support from significant others and protecting from further harm.

SPHERE 2011 proposes concrete guidance for Community based Psychosocial Support

The new SPHERE Project 2011 has included a new section entitled “Protection Principles” (SPHERE, 2011, pp. 24-44).  The following community-based and other psychosocial support are recommended.

Positive communal coping mechanisms such as culturally appropriate burials, religious ceremonies and practices, and non-harmful cultural and social practices should be supported.

Activities for children: Where appropriate, communities should be encour­aged to organize structured, supportive educational and protective activi­ties for children through non-formal means such as child-friendly spaces. Community protection mechanisms should include self-help activities that promote psychosocial well-being.

Help organize appropriate psychosocial support for survivors of violence. Ensure that survivors have access to community social networks and self-help activities. Access to community-based social support should be complemented by access to mental healthcare.

Integrated support system: Those agencies working on psychosocial support and mental health in various sectors should collaborate to build an integrated system of support for the population (see Essential health services – mental health standard 1 on page 333).

Clinical support: Establish mechanisms for the referral of severely affected people for available clinical support.

Psychological first aid should be available to workers who have experienced or witnessed extremely distressing events (see Essential Health Services—Mental Health Standard 1, p. 335).(SPHERE 2011, p. 73 & 335). Acute anxiety after exposure to extreme stressors (e.g. traumatic events) is best managed following the principles of psycho­logical first aid, which is often mistakenly seen as a clinical intervention. Rather, it is a description of a humane, supportive response to a fellow human being who is suffering and who may need support. It entails basic, non-intrusive pragmatic care with a focus on listening but not forcing talk, assessing needs and concerns, ensuring that basic needs are met, encouraging social support from significant others and protecting from further harm.

Psychosocial Support is one of the cross cutting themes in SPHERE 2011

SPHERE Project 2011 identifies psychosocial support as one of the cross-cutting theme for all sectors. This is the description offered in the Handbook. Some of the greatest sources of vulnerability and suffering in disasters arise from the complex emotional, social, physical and spiritual effects of disasters. Many of these reactions are normal and can be overcome with time. It is essential to organise locally appropriate mental health and psychosocial supports that promote self-help, coping and resilience among affected people. Humanitarian action is strengthened if at the earliest appro­priate moment, affected people are engaged in guiding and implementing the disaster response. In each humanitarian sector, the manner in which aid is administered has a psychosocial impact that may either support or cause harm to affected people. Aid should be delivered in a compassionate manner that promotes dignity, enables self-efficacy through meaningful participation, respects the importance of religious and cultural practices and strengthens the ability of affected people to support holistic well-being.(SPHERE 2011, p. 17).

WHEN……


Joseph O. Prewitt Diaz

Disaster cause stress in the family,

the children are the most impacted.

Children show signs of stress,

the family behaviors are stressed.

Parents seek emotional an spiritual fortitude,

Emotional and spiritual support reaches them.

Parents encourage their children to release stress,

they are able  to better manage their own stress.

Whether affected by tornadoes, the Mississippi floods or the earthquakes in Spain: Feelings, emotions, and behaviors are going to be the same

Joseph O. Prewitt Diaz

There are at least five causes for the behaviors and feelings of disaster-affected people: (1) anxieties over having lost everything;  (2) being a refugee in your own community; (3) daily routine has been disturbed; (4) the degree of vulnerability increases; and, (5) a feeling of uncertainty toward the future.

No matter what role or what disaster you have been assigned to work, there are actions that you needs to take to assure the well being and increase hope in the survivors:

• ·      Engage disaster-affected people in their own recovery.
• ·      Provide accurate and timely information.
• ·      Make sure that children and adolescent have a private space.
• ·      Assist community members to plan for actions that will bring a routine and normalcy back.
• ·      Foster voluntarism.
• ·      Provide spaces for community members to plan, manage, and monitor their own recovery.

Surely you will do a fine job by using psychosocial support activities suggested above, will assist the disaster-affected people to re-direct their behaviors and feelings toward reconstruction and an enhanced resilience.

Schematic for the development of a Community based Psychosocial Support Program-- Joseph O. Prewitt Diaz

The role of the disaster responder to protect children and assist in the development a sense of place

Joseph O. Prewitt Diaz

Children develop their sense of self and place in the world through their relationship to their parents. A child’s self esteem is built on the notion that, “I am of value as a person to the degree to which my parents take interest in me.” Children feel their parents’ interest in them by the amount of time spent with them. Many parents talk of quality time, but the best indicator of quality is quantity and consistency. These days when parents speak of quality, they really mean that they do not spend much time with their child, but when they do, they spoil them. This is not good for children. Rather, children need ample and regular attention from both parents in their normal living situations. Let’s face it, we only do spend time with people we value and children feel this.

When a parent is not active in a child’s life, the child may be emotionally crushed, feeling unworthy. As such, the child may no longer strive to succeed socially, academically and later, economically. Some children may even demonstrate these feelings of unworthiness through disruptive behaviour. Alternately, some children develop rich fantasy lives to protect themselves from feelings of worthlessness. They tell themselves their parent must be doing very important things otherwise they would surely be here. Such children grow up with unrealistic views of other people and relationships.

Many disaaser responders deal with parents that have been separated or lost their parents.   They feel the pain of the child whose heart may be broken and view them as dying the death of a thousand emotional cuts. They wonder what to tell the children to help them cope, recognizing the impact on their self-worth.

For the disaster responder in cahrge of children that have been separated from their parents this advice is suggested:

1.      Remain calm. Do not exhibit anger or frustration to the children, as this will only escalate their bad feelings. Rather, talk with the children about their feelings. It is appropriate to reassure them that they are loved. It is also appropriate to explain that the separation from their parents is a result of the disaster and not a reflection on the children. 

2.      Always have a back-up plan to structure your children’s time and a safe place for them to spend their time. This is not to say you spoil them with special attention to compensate for the period of separation or loss. Rather, children should not be left with nothing to do, otherwise they may wallow in their upset and get disruptive due to bad feelings. It is better that they learn to adapt and use their time constructively.

There is no way to fully protect children from disappointment in life. The key though is to keep the disappointment from being felt as a reflection of their worth. By helping children to understand the situation and making sure their time remains structured, you can ease the impact of the situation and teach them appropriate coping skills at the same time. This will equip the children to deal with other disappointments that life brings their way, so they can integrate the experience to their developmental process become more resilient and achieve well being.

FIVE BROAD CATEGORIES FOR INDICATORS OF COMMUNITY PSYCHOSOCIAL SUPPORT: Based on sense of place framework

1. Socio-cultural features of a community.

These include the political, economic, ethnic and religious history of a community: norms and values, the degree of community integration, levels of crime, incivilities and other threats to personal safety, and networks of community support.

2.  Physical features of the natural and built environment shared by all residents in a locality.

These include the quality of air and water, latitude, climate, etc. and are likely to be shared by neighborhoods across a wide area. Areas vary in their provision of decent housing, secure and non-hazardous employment, safe play areas for children.

2. Services provided, publicly or privately to support people in their daily lives.

These include education, transport, street cleaning and lighting, policing, health and welfare services. Again, how these affect people may depend on personal circumstances.

4. The participation of citizens in community life. 

How areas are perceived, by their residents, by service or amenity planners and providers, by banks and investors, may influence the infrastructure of the area, the self-esteem and morale of the residents, and who moves in and out of the area.

5. Engagement of local and outside stakeholders to improve the community.  Information, networking, looking forward. 

Sample Framework for community-based psychosocial support participatory research model

Sample Framework for community-based psychosocial support participatory research  model

Joseph O. Prewitt Diaz, PhD

Steps	Resulting in	Actions	Benefits
Full participation of community in identifying psychosocial issues of greatest importance.	Increased motivation to participate in the process.	Issues identified based on actual epidemiologic data and funding priorities.	Psychosocial concern(s) identified.
Community representatives involved with program design and proposal submission.	Increased acceptability of psychosocial  approach, include funds for community	Program designed and funding sought	Design based entirely on expressed community needs and feasibility; funding requested primarily for project activities.
Community representatives provide guidance regarding recruitment and retention strategies of local volunteer and paid staff.	Enhanced recruitment and retention.	Participants, volunteer and paid staff recruited and retention systems implemented	Approaches to recruitment and retention based on scientific issues and "best guesses" regarding reaching community members and keeping them involved in the psychosocial support project.
Assessment instruments developed or adapted with community input and tested in similar population	Potentially sensitive issues handled better and increased reliability and validity of measures	Assessment instruments designed and data collected	Assessment instruments developed, adopted/adapted from other psychosocial programs.
Community members take on a major role in PS intervention development.	Assures greater cultural and social relevance to the population served, increasing the likelihood of producing positive change.	Intervention designed and implemented	Program staff design intervention based on literature and theory.
Community members assist program personnel with collection, interpretation, dissemination and translation of findings.	Assures greater sensitivity to cultural and social norms and climate and potential group harm and enhances potential for translation of findings into best practices.	Data analyzed and interpreted, findings disseminated and translated	Program personnel report findings to community members, the donor, and other stakeholders.

Community based Psychosocial Support: Sample intervention and impact indicators

 “Community based psychosocial support is concerned with the interaction and dynamic relationship of the psychological, social, spiritual and cultural components of a disaster affected peoples’ life and encourages active community participation to plan, implement and monitor activities that enhances protection, resilience, and well-being”.

Standard for community based psychosocial support

Improve individual and community psychosocial well-being.

Sample Key Intervention Indicators:

In community based psychosocial support program indicators are phase specific and are formulated by the disaster-affected community with technical assistance as needed.  Below please find four sample indicators:

·      Affected people have access to an ongoing reliable flow of credible information.

·       

·      Affected people are reunified after the disaster.

·      Children and adolescents have access to formal and informal schooling as well as recreational activities.

·      Affected people have the right to plan community based psychosocial support activities that promote, calming, security and enhance resilience.

Sample Impact Indicators

The affected people report feelings of:

Calmness in their surroundings.

Security in schools and community.

Being included in decision making

Value in their contributions toward community well-being

Increased motivation to survive, succeed, and move on

SPHERE Project 2011, and IASC/MHPSS 2007).