Psychosocial support is a simple tool for protection and community development

Joseph O. Prewitt Diaz[1] PhD

An increase in natural disasters and conflicts, an awareness of disaster-affected peoples needs, and a group of people that assured that the human rights of disaster affected people are protected has created the synergy for psychosocial support to be acknowledged and placed at the forefront of disaster response.

This synergy has created guidelines and standards that are to be upheld in responding to a disaster. But, what is community based psychosocial social support? Form my optic it is a set of activities that involves psychosocial actions, planning and establishing of  “place”.

Psychosocial actions are the result of community members joining together to identify those activities that impact the quality of life. After a disaster, community mapping, and gathering of data through inclusive community meetings leads to identifying projects that will increase voluntarism, contribute to change, and fosters social planning.

Psychosocial planning consist of three phases: In the first place establish dialogue between all segments of the community, decide the risks and resilience factors, and describe strategies to influence leadership and external stakeholders to develop policies that will impact eh affected-community. Secondly, move from developing policies to implementing policies by identifying programs that are needed to address risks factors and the mechanics of developing the program, Thirdly, engage the community members in activities that will address the needs of all segments of the community. These activities lead people by defining their “place” by focusing on feelings, motives and purposes of the affected-people.

Community based psychosocial support is a developmental cycle by transforming victims into practitioners, and new arrivals into volunteers. There changing knowledge, skills and communication within and without are part of a developing identity--- a re-established place.

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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 was awarded the Distinguished Service Award from the Indian Red Cross Society for the development of psychosocial support programs in several Indian States. 

Learnings from Psychosocial Supports projects managed by external “Experts” after disasters

Joseph O. Prewitt Diaz,[1] PhD

I just completed over fifty after action reports of psychosocial support programs during the 2004 South Asia Tsunami and the January 2010 Haiti Earthquake. We were trying to understand the impact of external psychosocial experts in diverse groups ranging from community organizations (local NGO’s and GO) to work organizations (INGO’s representing the UN family the Red Cross family and the Faith based family).

Findings:

1.     Many projects were conducted to achieve justice (defined as equal opportunity or equity within a given context). Societal equity in several cases was defined based on the world-view of the external experts rather than consulting the disaster-affected people. Shared resources and mutual concerns for each other were not considered in the development of the projects.  This resulted in a lack of knowledge about shared but unspoken values, norms and cultural practices. The projects lasted as long as the ex-patriate expert remained in-situ and disappeared or was reformulated as soon as the expatriate left the area.

2.     Extensive and excessive use of participation in coordinating groups created a “we-they” relationship with the disaster-affected groups. This let to strong monolithic team culture that focused on the groups “own” job and a self-protective stance (ie. PSP group, WASH watsan groups or the protection cluster).

Lessons learned

1.     Reach out and develop connections within the context of the affected-people. This will foster mutual respect, and a desire to work together, volunteer, identify and use own social capital, and rely on community leadership and skills to improve the well-being in their communities.

2.     Neutralize the “we-they”. Some of the most mentioned suggestions were: (a) community meetings and “melas” (focused meetings), (b) assure representation of all segments of the community (women, children, elderly and differently abled among the most important), and (c) through needs assessment and community mapping activities identify and prioritize particular problems or concerns, and identify the methods on how to tackle the challenge.

3.     Spend significant time building trust and showing respect for the disaster-affected people.

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When feeling afraid brings out the best in you!

Joseph O. Prewitt Diaz[1]

I have spent a large portion of my life feeling afraid and reacting to that feeling. Insecurity, not feeling secure after a catastrophic event, is a normal reaction to an abnormal event. But when you spend a large portion of your life feeling afraid, in spite of external or environmental stimuli, the normal behavior is responding to every stimuli (good, bad or indifferent) by being hyper vigilant, hyper tense, and over reacting constantly, in everyday life, these types of individuals react abnormally to a normal event.

Four sources may cause feelings of insecurity: (1) mother, (2) immediate family, (3) religious leaders, or (4) teachers. External control begin with “Don’t get wet, you will get sick” or don’t walk in the dark room “te coje el cuco” (the buggy man will grab you), or “good boys don’t do this or that”. Implying that since you were doing and unwanted action you were not a good boy. As you grow older you go to church with your elders, while you are quiet, prayful, and do what adults do, everything is good. The minute you start acting out your boredom, you are bad “the devil is surely going to get you boy!” My father used to say.

As you grow up the external stimuli get more sophisticated and hard to follow. “Joe is a good boy, he is at times misguided”. Boy that teacher really treated me well she said I was a good boy. I proudly walk out with my mother and as we turn the corner to go down the stairs, my mother’s hand hit me in my “cachete”. “What did I do”, I ask. My mom responded you made me look bad, it is as thought I “never redirect your behaviors” (my mother was a teacher too, and more difficult to understand).  !Mamii “she said I was  a good boy.” “Yeah, did you hear the rest”. “No mom I forgot”. That initiated an hour length discourse into all the bad things I did, and how many times I embarrassed her.

As I grew older, I was skinny, shock a lot (no me podía estar quieto) and kept quiet.  Well, soon after my 15^th birthday, experiencing personal difficulties in turns of understanding what satisfied the adults around me I went away. The little fish had outgrown his pond.

In the ebb and flow of life, I found that I was very good in crisis situations. I was perceived as functioning in a normal way during abnormal times. I had found my calling, as time went on I volunteered in community initiatives. At times I took on more than I could, just so that I could find a solution to the situation. “Yo era diferente” for sure. I became a very good initiator, but very bad at follow through.

Even though I am older and my energy is dwindling, there was a time when at the sound of a radio tune, you would see the white and red jeep speeding down the road. This big guy, got off, ran to the Job Manager and said “Disaster Joe at your service sir.”

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[1] Dr. Prewitt Diaz is the recipient of the 2008 APA International Humanitarian Award for service rendered through the American Red Cross in disaster situations. 

PSYCHOSOCIAL SUPPORT PAVES THE PATH TO A NEW WORLD

Joseph O. Prewitt Diaz[1] PhD

Psychosocial support is a cross cutting issue in the SPHERE Project 2011. The main role of psychosocial support is to assure that the emotional needs of affected-persons are addressed as they recover from major disaster or conflicts. Community based psychosocial support is a tool that provides support and equal assess to services to the oppressed and the oppressors. It is participatory in nature and providers a mechanism where all segments of the community are able to identify the risk and resilience factors in their geographic, ecological, cultural, economical, spiritual, social and psychological place. The activities provides a space for all members of a community to identify their losses, what they need to rebuild, their social capital and what the affected-communities need from the outsiders and  other stakeholders.

The approach has two predominant segments: a clinical and a psychosocial segment. The clinical approach begins with psychological first aid, and then the small groups of disaster-affected people that need further clinical evaluation are referred for counseling. In a small number of cases, medical personnel that may use medication to alleviate the traumatic stress, anxiety and depression raising from the difficulty of coping with the disasters and the feelings of hopelessness and helplessness experienced by some.

The psychosocial support segment provides for participatory community assessment. Most of this work is qualitative and relies on community mapping and narratives using pictures as stimuli for community members to express their needs. Volunteers are the backbone of this segment. They will develop safe space for children to play, and informal schooling for adolescents, women, and the elderly to develop skills to rebuild their “place”. Slowly, slowly, the disaster-affected people regain their desire to move ahead and enhance their resilience. The narratives with small groups every six-months give a glimpse of the movement made by the affected-communities from their own perspectives, and needs to continue to change and to be modified.

Psychosocial support is synonymous of constant activities, increased communication, ownership for the process and product, voluntarism and re-establishment of place. Psychosocial support  paves the  path to a bright new world!

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[1] Dr. Prewitt Diaz is Visiting Professor in the School of Law and Director of the Disaster Law and Policy Studies Center. He is the recipient of 2008 APA International Humanitarian Award.

Contextually appropriate psychosocial support

Joseph O. Prewitt Diaz[1], PhD

A couple of months ago SPHERE 2011 was unveiled in several capitals around the world. This document provides the understanding of the humanitarian field about the standards to use to assure the “Do no harm” maxim. This event signaled a quantum leap in humanitarian assistance. It recognized that humanitarian assistance had two significant parts: (1) assistance and (2) protection. The importance of psychosocial support was recognized in the document as an important tool that will assure protection through (1) contextual sensitivity, (2) culturally appropriate techniques, (3) the strengths of local networks, and (4) focus on emerging victorious.

Contextual sensitivity. Bolton and Tang (2002) were trying to understand how a village fostered mental health support using qualitative research tools. They decided that the best way to gather their data was to sue the community members as key informants. A by-product of the study was a model on problem identification, symptoms, solutions and monitoring of the work being conducted. Sharing this work with some colleagues, the issue of time in developing a project arose. We know from successful models after disasters that the time it takes to identify the needs, prioritization, and project development are psychosocial support tools in themselves. They strengthen the capacity of the community to trust each other, identify social capital, and enhance their solution focused capacitates.

Culturally appropriate techniques. These have a great value in helping the outsiders understand what works and how it works within the local norms, culture, and spirituality.  While we are trying to comply with donor intent and requirements, we must recognize that we are outsiders in the disaster setting and must rely on development of trust, a two-way communication system, and a desire to truly belong to the community you are trying to help.

Strength of local networks. I reached Banda Aceh with a contingent of mental health workers. I went to the local Red Cross and asked where were the local personnel. The man looked at me with puffed eyes “they are no more”. It took a year to get a new group on-line, community and school groups functioning in their respective settings. It was hard to explain to my “higher ups” why it was taking so long. The correct answer was that the local community would take as much time as needed to develop the necessary networks, to get a semblance of what was, before they were comfortable accepting assistance from the outside.

Focus on emerging victorious. I am vehemently opposed to the use of standardized testing to measure the effects of psychosocial support programs. Without taking much time: “it is simply wrong”. The basic problem is the reliance on a deficit model. Most of the people have a “problem” generated or exacerbated by the disaster. The focus on providing psychosocial support to affected-people is to help them recognize their resilience, feel victorious and achieve well-being. Most communities want to return to “place”. It seems that in assessing risks and resilience factors, people gain a self-respect, capacity for problem solving, and the capabilities to use local skills to achieve solution focused activities. At the end of the day, the disaster affected people need to feel victorious.

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

Pictorial tools encourage dynamic processes that permit a holistic evaluation of risks and resiliency factors

Joseph O. Prewitt Diaz[1], PhD

Pictorial tools in disaster-affected communities promote, participatory processes and dynamic processes that encourage disaster-affected people to initiate a self-propelled process of recovery. Disaster-affected people have the freedom to device their own methods of resolving problems by developing intervention that will work for them.

Pictorial tools are simple and provide a powerful space to elicit complex solutions. They keep the affected people active by providing the opportunity to think about the information being presented. These tools are used to search and identify different alternatives to attend to community needs.  One such tool, community mapping, promotes self and community knowledge that leads to community guided decision-making.

Participatory processes are used in such a way that they enhance the perspective between and within gender, and diverse community groups. Marginalized people may use illustrations to formulate a story and communicate their needs to stakeholders. Using illustration has increased group thinking and encouraging proposing organizational approaches.

The results of establishing equivalence lead to highlighting the importance of visual literacy amongst the affected people. By attempting to use pictorial tools universally, disaster-affected people develop the ability to (1) understand and make visual statements, (2) understand the world around them visually, (3) understand relationships, and systems of which they are part off, and (4) integrate personal experience and imagination with social and psychological experience.

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