IMPLEMENTING PSYCHOSOCIAL SUPPORT PROGRAMS: THE AMERICAN RED CROSS EXPERIENCE

Joseph O. Prewitt Diaz and Anjana Dayal

American Red Cross, New Delhi, India

April 10, 2007

Note to the reader:  This is archival data not reported by Mr Steven Powqell in his " Psychosocial Programming: Meta Evaluation-American Red Cross Mr. Steven Powell" 2010.

ABSTRACT

The purpose of this report is to outline an approach utilized by the American Red Cross in the development of a psychosocial support program to serve the survivors of the 2004 South Asia Tsunami. The report present the theoretical basis for the components of the program: staff development, community and school interventions. A discussion of ‘sense of place’ sets the stage for the interventions planned and implemented. International standards are presented and the framework for using these standards is discussed. At the end of two years the program has served over 350,000 beneficiaries in India, Indonesia, Republic of Maldives and Republic of Sri Lanka.

INTRODUCTION

Psychosocial support is an accepted practice during the recovery and reconstruction phases following disasters. Saraceno (2006) suggests that psychosocial support addresses the reactions to enormous losses, which are often ignored or forgotten in the immediate aftermath, and during the reconstruction phase, of a disaster.  Psychosocial support builds on the knowledge and awareness of local needs and protective factors to provide psychological and social support to people affected by disasters.  The aim is to enhance survivors’ capacity to achieve psychological competence.

Psychosocial support identifies the survivor as the main actor in the reestablishment of ‘sense of place’. They are actively engaged in making communal decisions, taking the time and making an effort to choose their goals, identifying resources and making action plans − all of which empower them and their communities.

There has been a move in the past ten years to develop Psychosocial Support Programs (PSP) as part of the repertoire of services offered in the aftermath of a disaster. Recently the IFRC (2006) recognized the importance of the psychosocial support programs. The IFRC reports that “one area where the International Federation has had considerable impact is in providing psychosocial support in post-disaster situations.” (p. 21).   This was an area of work much appreciated by the Host National Societies. It was recognized that the need for psychosocial assistance after a major disaster is likely to persist over a much longer time than the usual intervention period of emergency services. Consider making psychosocial support programs a core area for the International Federation in recovery; encourage mutual support for psychosocial support programs among National Societies from the same region (IFRC, 2006, p. 21).

In 2002, as a result of the Gujarat earthquake, the Indian Red Cross developed a strong Disaster Mental Health and Psychosocial Care Program. The materials prepared by the Indian Red Cross Society (IRCS) have been used extensively in South and South-East Asia as valuable resources following the 2004 tsunami. Trained IRCS members have joined the American Red Cross (ARC) in providing a timely and strategic response immediately after the tsunami.

Following the 2004 Asia Tsunami and the Pakistan Earthquake of 2005, psychosocial support activities have come to the fore. As psychosocial support continues to be identified by the humanitarian community as a tool for alleviating suffering and enhancing resilience of the survivors, the question that arises is: what constitutes psychosocial support intervention leading to reestablishment of ‘sense of place’ and achieving psychological competence. This paper attempts to address that question.

2.0. Theoretical Framework for the Psychosocial Support Program

2.1. Sense of place

The term ‘place’ denotes humans’ subjective experiences and meanings of the locations which they inhabit (Bott, Cantrill, and  Myers 2003). Steele (1981) noted several types of place experiences (immediate feelings and thoughts, views of the world, intimate knowledge of one spot, memories or fantasies, personal identification, etc.) and several major characteristics of place (identity, history, fantasy, mystery, joy, surprise, security, vitality, and memory).

The recent tsunami highlighted the importance of memories in determining place attachment, as well as of control over meaningful space, the manipulation of that space, and the re-creation of some essence of significant past settings in later life. Such acts have important psychological consequences: we are motivated to effect those changes in order to discover, confirm, and remember who we are. Our memories of, and self-expressions through, settings are profound reminders of self-identity, especially at times when that identity is weakened or threatened (Cantrill and Senecah 2001).

Tuan (1974) used the term ‘rootedness’ to denote the merger of personality with place, based on living in a location for an extended length of time. Prohansky, Fabian, and Kaminoff (1983) defined ‘place identity’ as a relationship in which, through personal attachment to a geographically locatable place, a person acquires a sense of belonging and purpose in that place, which gives meaning to life. Moore and Graefe (1994) considered ‘place identity’ to be the valuing of a particular setting for emotional-symbolic reasons, such as profound ‘first’ experiences, or being from a place.

2.2.  Loss of place: Most Serious Impact of a Disaster

Fullilove (1996) suggests that any catastrophic event causes a loss of place and triggers the need to survive. Human survival depends on having a location that is ‘good enough’ to support life. People interacting in a psychosocial environment are sensitive to spoken and unspoken dynamics of power. Messages of acceptance and mutual respect are essential for the creation of strong community networks. Those that do not bind the individual to the group may leave people feeling isolated, without a sense of common purpose. Over time, survivors develop a unique perspective of what their ‘place’ is.

There are different stages of human responses during the recovery and reconstruction phases that are similar to the phases of community development.  In effect, the establishment of self is nothing more than reconstructing a sense of community, and concludes with the development of competence.

2.3.  Re-Establishing a Sense of Place

Participatory assessment is one of the most frequently used techniques in assessing the community needs, determining risks, and identifying community resources. The purpose of participatory assessment is to give a voice to those community groups that are traditionally not heard. In this section, four forms of participatory assessment are discussed: (1) community mapping, (2) community three-dimensional models, (3) community inventories, and (4) focused groups.

When the community is ready to design a community resilience project, it must identify and prioritize the problems that need to be tackled. It needs to learn techniques that involve all community members in the identification of problems that affect psychosocial well-being. Therefore, community members need to learn the principles and skills of participating in evaluation, assessment, and appraisal. There must be agreement and consensus among community members that the problem chosen to be solved is the one with the highest priority. An accurate appraisal by the community members is necessary before the members can decide upon priorities and agree on a project to initiate action.

3.0. Standards, Indicators, and Guidance

Attempts in the last three years to include psychosocial support in emergency response guidelines and standards have witnessed the development of standard tools and guidance documents by SPHERE Project (2004), Inter-Agency Network for Education in Emergency (INEE) (2004), and Mental Health and Psychosocial Support developed by the Inter-Agency Standing Committee (MHPSS/IASC) (2007).

The SPHERE Project defines ‘social intervention’ as that which primarily aims at social effects. ‘Psychological intervention’ means intervention that aims at psychological (or psychiatric) effect. It acknowledges that social interventions have secondary psychological effects and that psychological interventions have secondary social effects, as the term ‘psychosocial’ suggests (p. 291). 

INEE defines psychosocial support as a methodology that fosters the reconstruction of local structures (family, community groups, and schools) which have been destroyed or weakened by a disaster, so that they can provide appropriate and effective support to those suffering severe stress resulting from ‘loss of place’ (Nicolai 2003).

The most recent MHPSS guidance for Mental Health and psychosocial support developed by the IASC (2007) enables humanitarian actors and communities to plan, establish, and coordinate a set of minimum responses to protect and improve people’s mental health and psychosocial well-being in an emergency. Minimum responses are the first and essential steps that lay the foundation for more comprehensive efforts that may be needed over the life of an emergency (including the stabilized and early reconstruction phases). These guidelines bridge the traditional divide between mental health and psychosocial support programs during disaster recovery and reconstruction.

The guidelines contain strategies for mental health and psychosocial support to be considered immediately before and after the acute emergency phase. These ‘before’ (emergency preparedness) and ‘after’ (comprehensive response) steps establish a context for the minimum response and emphasize that they are only the starting point for more comprehensive support.

These guidelines (SPHERE, INEE, and IASC/MHPSS) serve as a roadmap for the development of psychosocial support programmes during the acute, recovery, and reconstruction stages following a disaster.

3.1. Initiating Community Contact

Psychosocial support practices include several steps which assist the community in the identification of perceived and felt needs. Among the lessons learned from the American Red Cross PSP is that several steps need to be taken with the community as the main actor, including: (1) inputs from all community members through community mapping exercises, (2) systematic information to assist the community in prioritizing its perceived needs, (3) identification of community resources and human capital, and (4) involvement of community members as executors of the projects (planning, developing, monitoring, and reporting).

Community inputs are obtained through community mapping exercises and by preparing community facilitators to assist different groups in the process of developing a community-driven agenda for recovery and reconstruction. Communities develop their capacities based on their recognized strengths and solidarities. Including communities in managing their own resources (Greenberg and Sundararajan 2006) is the result of a mapping exercise. Equity and respect for human rights are central to the recovery process. Preparing Red Cross volunteers, branch personnel, and community facilitators, as well as understanding the language of distress of the community, is called the ‘gestation period’ of the project.

The way of enhancing the capacity of the community to look at itself is through community mapping. The psychosocial community committee, comprising Red Cross volunteers, community facilitators, traditional healers, and trusted elderly and under-represented groups, participate in a physical walk through the community, and draw a map of the area. The map includes communal facilities, buildings, roads, utilities, human capital, and environmental strengths and risks. After the map has been drawn, the community facilitators, along with small diverse groups (women, children, adolescents, and elderly men), develop separate maps.

Next, all the small groups prepare a large three-dimensional map, combining and synthesizing what is included in all small-group maps. These maps reflect the perspective of the participants and reveal much about local knowledge of resources, land use, and settlement patterns, or household characteristics. Community mapping is a dynamic process, and reflects the worldview and focused objective of the exercise; therefore it must be reviewed every quarter. In an integrated program, it is essential that different groups address the focused objective and then utilize photography and tabletop layouts to interpose layers (similar to GIS technology).

In this activity, the Red Cross volunteer identifies someone who may assume the role of community facilitator and who could introduce the volunteer to a small circle of families, friends, and acquaintances. These networks are used for initial interviews and for observation. Since everyone knows many other people, the Red Cross volunteer and the community facilitator work their way through social groups, finding more and more people to talk to, and being allowed into more and more homes.

This process takes considerable time since virtually no one is willing to talk in depth about his or her disaster reactions and subsequent experiences on the first visit. Time, familiarity, and ‘going with the flow’ are needed until enough rapport is established so that the Red Cross volunteer can take out a note pad, or videotape the interview.

Once the primary barriers are down, the volunteer and the community facilitator (with supervision by ARC expatriate staff) are able to return and gather more information from the community members. The Red Cross volunteer and the community facilitator gain the trust of the survivors, and people share their views with others who support, create, and run the community-based PSP in small focused groups.

The five-step process involves PSP personnel from outside assisting the local branches and communities in developing their own resources. There are typically five specific stages in the participatory process followed by the ARC/PSP model: (1) entry into the community, (2) sharing of information gathered during initial interviews with families, (3) information review and confirmation with ARC personnel to come up with themes and key informants in the community, (4) focused group interviews on selected topics, and (5) exit from the community. In all cases, these are cyclical processes which may take between one to three months.

4.0.  Core Components of Psychosocial Support

4.1.  The School Program

The school-based program is composed of several projects that are oriented towards understanding the psychosocial competence of children, teachers and volunteers.  Teachers learn to listen to children and plan school activities with them.  Creative and expressive activities create an environment where students can begin to express themselves in a safe and non-judgmental environment.

A.  School Psychosocial Crisis Response Planning

The first step in developing a psychosocial support program in schools is to work closely with teachers and volunteers so that they understand:

•     The role of teachers and the school in promoting the physical and emotional development of children,

•     How to develop methods for classroom management that promote positive behavior changes and a safe and secure environment, and

•     How to create, and the importance of creating, a learning environment that is safe for children to express themselves and learn ways to communicate positively.

The American Red Cross PSP program uses participatory methods with all school groups (children, teachers, volunteers, parents, and other adults in schools) to identify mental health and psychosocial needs, provide staff development for teachers and other adults (teachers, community social workers, and non-formal educators) and assist the school community to establish a psychosocial crisis response plan. 

Teachers and other school staff and volunteers receive relevant and structured capacity-building activities, teaching aids, and tools to develop their skills.  Using these activities and tools enables them to provide psychosocial support to students and their families when needed and promote students’ development of psychosocial competence according to the needs and circumstances.

Teachers are encouraged to share their adaptations and experiences with other adults in the school which may be included in the teacher-training curriculum. Teachers and other school personnel are provided with regular supervision and capacity-building activities on topics related to psychosocial competence and support for their own psychosocial needs.

Teachers and other adults start the process of developing a plan by identifying what constitutes a crisis in their respective schools.  Once the definition of crisis is made operational and the teachers understand the concept of vulnerability and protective factors, they then learn to conduct a situational analysis of their school grounds.  The analysis is recorded by preparing a three-dimensional map of the school grounds.

The two questions that are answered in this exercise are:

1. Where is our particular exposure to the threats identified and who is at risk as a result?
2. How and why are we vulnerable?

Usually teachers spend a lot of time discussing external sources of the problems.  Once they get back to their map, the discussion turns inward to the reality of their school situation and challenges in the grounds around it.  The teachers identify the vulnerable population that may be at risk (kindergarten classes, children with ‘exceptional’ needs, or those that are physically or mentally handicapped). School mapping is carried out to understand the risks in achieving psychosocial competence of teachers and students.  Teachers and students are exposed to capacity-building activities that prepare them to handle a crisis or an emergency. Exercises and simulations are conducted every two months to make sure that all members of the school community are able to perform their assigned tasks. Since schools do not have the resources for the equipment needed for this activity, the program provides the equipment.

The teachers also identify available school resources that can support the activities to reduce crisis-related distress. They identify the key elements of the response strategy in cases of crisis or emergency.  This exercise broadens the understanding of the teachers and students about the risks which they are exposed to and the resources available to cope with those risks.

The primary stakeholders for all school activities are children. Therefore, ARC’s PSP focuses on developing the skills of children as an investment for the future of the community and to make them educated citizens, leading to the well-being of the community and the nation.

The final part of the capacity-building activities in the ‘Safe School Program’ is the appointment of the coordinating committee and five operational committees. The coordinating committee manages the training, simulations, and response. The five operational committees are:

1.   Evacuation,

2.   Damage Assessment,

3.   Physical First Aid,

4.   Psychological First Aid, and

5.   Administrative/Coordinating Committee.

These five committees are made up of teachers, students, and other adults in the school. Ultimately, the purpose of appointing these committees is to be able to return the children safely to the local authorities and the parents.

B.  Facilitating a School Environment that leads to Psychosocial Competence

Once the school has developed the ‘Safe School Program’ and children and teachers are capable of carrying out the activities in the plan, the projects turns its focus on preparing teachers to facilitate education for the children in an environment that nurtures learning and provides teachers with an understanding of all the students. Usually this activity begins in the early reconstruction phase of the disaster (the guidance for this activity is taken from the INEE Standards).

Most classrooms participating in the program receive school chests and recreation kits. The chest contains drawing books, pencils, crayons, colored clay, and skipping ropes, which are useful in engaging children and provide a window for expressing feelings and sharing experiences. The recreation kits provide board games, balls, musical instruments, and other outdoor games. The teachers are given clear instructions about the contents of each kit and they organize a one-day workshop in developing activities that are contextual and age-specific for the children in their classrooms. The school chest and recreational kit serve as conduits for psychosocial activities.

C.  Organizing Expressive and Creative Activities in Schools

To alleviate disaster-related stress in students, counselors, and other school personnel could use one of the three culturally appropriate approaches:

1. The talking approach allows children to talk about their feelings and experiences related to the disaster. The sequence to follow while using the approach is to speak about disasters in general, discuss their specific disaster, and talk about their personal experience during the disaster.

2. The drawing approach facilitates children to express their feelings using a non-verbal medium. The stimulus could be a question such as, ‘Where were you when the disaster struck?’ The ARC experience has been that collages are a powerful means of expression.

3. The writing approach can be used with older children and adolescents. Utilizing either drawing, paper clippings, or pictures as the stimulus allows students to write about their disaster-related experiences.

Under the program, expressive and creative activities (drama, drawing, writing, singing, dancing, group discussions, arts and crafts, collages, story telling, plays and community theatre) are organized in the schools. These activities allowed the children in the target schools and communities to communicate their feelings.

      4.2. Re-establishing the Community’s ‘Sense of  Place’

The objective of engaging the community in a systematic process of looking at themselves and determining their strengths and human capital is called ‘Re-establishing the Sense of Place’. It is experienced that the community interventions that are planned and developed for enhancing resilience and assisting the community in using their own resources for re-establishing their ‘sense of place’ are proactive, preventive, and positive in minimizing psychological dysfunction. Ultimately the program strives to achieve social and psychological competence in survivors and emerging communities.

 The programs’ objectives are to:

·      Conduct participatory assessment and context analysis of the local community’s resources, services, and practices, including local resource people and community members,

·      Provide capacity-building and supervise community-based psychosocial workers administering emergency support to alleviate disaster-related distress, and

·      Address pre-emergency negative psychological or social behaviors and assist the community members to identify potential resilience activities which will contribute to the community psychosocial competence.

The program identifies community volunteers and provides capacity-building to them so that they can become community facilitators. The community facilitators assist in the development of community-owned and managed psychosocial support activities by promoting positive coping, influencing individual and group behaviors, and strengthening networks that lead to psychosocial competence.

Table 1 below briefly outlines the qualifications of the community facilitators. In every community, the effort is to identify one person in every 50, as a community facilitator. There are three distinct sets of activities that have to be developed by community facilitators: (1) informal schooling, (2) informal health, and (3) community organization. All program segments rely on resilience projects to help the community move forward. Thus the challenge in developing community programs is to recognize that by enhancing resilience and assisting the community in attaining its ‘sense of place,’ psychosocial competence is achieved, which is the focus of community-based psychosocial support programs.

Table 1:  Three Lines of Community Service for American Red Cross PSP Community Facilitators (36 hours of Capacity-Building Activities and 100 hours of Supervision)

Informal schooling	Informal Health	Community cohesion and resilience projects
Identify children, adolescent and adults that are interested in vocational education, literacy, and numeracy.	Coordinates with the formal health system regarding psychosocial needs and community mental health	Mobilizes the community by assisting in the organization of community resilience projects.
Organize safe zones within the community where creative and expressive activities take place.	Promotes psychosocial well-being through community participatory activities.	With the community, assists in conducting community mapping to identify psychosocial risk and resources.
Assists in organizing literacy, numeracy, and vocational education activities in the community.	Promotes activities that address the importance of strengthening networks and the social factors.	Assist representatives of the community to organize resilience projects
Assist the teachers in planning and solution-focused activities with children and adolescents to enhance their problem solving skills.	Provides structured social services outside of the health sector. Including developing skills to conduct burial rites.	Assist the representatives of the community to identify human capital
Promote psychosocial support and self care among the children and adolescents.	Promotes promotion of mental health and self care.	Assists in the organization of psychosocial support brigades in the community.

A.  Informal Schooling

The ‘informal school program’ works with children below five and out-of-school youth and marginalized groups of handicapped individuals, elderly, and widows. Each of these informal schools is provided with a recreation kits and other psychosocial support materials.

Education within these schools is facilitated by the community facilitators and led by volunteer teachers.  In the morning sessions, the focus is on education for children under five. The community facilitator, informal school teacher, and adults and adolescents from various marginalized groups assist in educating this group. In the afternoon sessions, the activities focus on education for out-of-school youth and tutoring for children who need extra attention. These informal schools also serve as a venue where community elders come together to educate children about their common history and culture, and enhance their vocational skills. 

Informal schooling includes creative and expressive activities to facilitate the involvement of the whole community including elderly, physically handicapped, widows, and children in the recovery process. Not everyone feels comfortable expressing themselves verbally.  Creative and expressive activities such as drawing, story telling, art and crafts, can provide creative ways for these individuals to communicate their feelings. Community-based skits and story telling has also proven to be a powerful and effective way of venting feelings; it is a simple healing process with feeling of enjoyment and togetherness. These types of activities are used both in the school and community-focused activities to facilitate expression of feelings, reduce distress, and enhance a sense of belonging.

B.  Informal Health Activities

Community health is divided into two sectors: 1) Trained medical personnel in the community health clinic or the local hospital conduct formal health activities, and 2) Community members carry out informal health activities.  These interventions usually rely on the traditional community resources, belief systems, and the definition of psychological well-being before the disaster.  This level is broad and covers:

1.   Strengthening of support provided by pre-existing community resources,

2.   Community participatory activities that include getting members of the community together in identifying and planning community activities to reduce mental and social distress and promote self care,

3.   Activities that address important social factors to reduce social suffering,

4.   Structured social services outside the health sector, and

5.   Strengthening of community networks through community activities that ensure that isolated persons come in contact with one another and mutual support is generated.

C.  Community Cohesion and Resilience Projects

The community facilitator is in charge of mobilizing the community and has responsibilities that are similar to someone working in disaster preparedness or response. The difference is that the community facilitator brings together representatives of all segments of the community for understanding the community and to plan a project jointly. Planning, conducting, and evaluating a project leads to a more cohesive community with renewed skills for developing itself.

Keeping the deliverables in sight, the training of the community facilitator consists of elements of leadership, group development, and conflict resolution, and mapping and developing a community plan.  The plan should identify orphans and vulnerable children, including children with physical disabilities, children in women-headed households; identify widows and widowers; identify other vulnerable populations (those with physical disabilities, chronic diseases, the elderly, etc.); and establish the segment of population in need and the ratio that is being served.

4.3. Organizing, Developing, and Implementing a Community Resilience Project

        

Planning resilience projects is a ‘futuristic activity’; it is proactive, sequential, and collaborative. Built upon set of core choices, it must include necessary details of timing, budget, and phasing. In emergency settings, the surrounding chaos, suffering, and time pressures push humanitarian agencies to act quickly, without learning about local beliefs and practices. Due to this haste, it becomes more likely that culturally inappropriate programming will be imposed. The meaningful participation of project beneficiaries in the assessment, planning, and implementation stages is essential for generating appropriate activities and a sense of ownership and increased likelihood of sustainability.

This section describes how resilience projects enhance psychosocial competence in disaster-affected communities. Resilience projects are engaged in a cycle where the community assesses, formulates, and evaluates the participatory interventions, which through cycles of response and reconstruction, recognize community resources and establish a ‘sense of place’ for the survivors. The more a community takes charge of identifying its own resources (seeking indigenous solutions and engaging in solution-focused activities), the quicker is recovery and the achievement of psychosocial competence.

To ensure that programming is inclusive, contextual, culturally sensitive, and appropriate, it is valuable to consider the four key questions that determine the response to disaster and assist in developing a comprehensive community-based PSP:

•     What do we want? All community members get together and identify their psychosocial support resources and needs. They rank the resources and needs in two lists and prioritize with the help of the community facilitator. They identify what they want. This is the basis of the community-based psychosocial support intervention.

•     What do we have? Knowledge about the capacity of the community, its resources, strengths, and liabilities, by analysing the outcome of the assessment process gives the community an insight into its actual rather than felt needs.

•     How do we use what we have to get what we want?  The community identifies the resources it has in terms of manpower, tools, land, etc. and in a participatory process, assesses its utilization to achieve desired results.

•     What will happen when we do?  The outcomes of the community effort are compared with the program objectives, whether achieved or not.

‘Participatory Situation Analysis’ identifies and defines the characteristics, protective factors, and problems specific to particular categories of people. Information for situation analysis and ‘problem definition’ collected from the community members is valid, reliable, and comprehensive.

The qualitative and quantitative ‘Participatory Assessment’ technique identifies the response mechanism for community resources and determines risks. The assessment process involves the whole community in decision-making, and encourages community members to take responsibility for any facility or service that may be installed in the future.  Community assessment sets the stage for the resilience project. Before implementing community-based PSP, the beneficiaries and potential funding sources should set up clear goals. The support organizations function as a facilitator, providing structure and stimulation. Community members are normally and usually willing to engage in the process and learn the skills in the process. The outcome of the assessment acts as a baseline or data for problem identification and measuring progress, and is therefore an element of community-based monitoring and evaluation.

A.  Focus Group Discussions

Focus group discussions are useful when there is a range of experiences and opinions among members of the community. For support agencies, it is best to work as a facilitator, leading the discussion and making a record.  The chosen discussion topics should be fewer and more specific than taken for the general community. Separate sessions for the different interest groups are conducted, their contributions carefully recorded, and brought together to share their special concerns. Special focus groups provide an opportunity to work separately with different groups that may find it difficult to work together at first, but the facilitators’ efforts brings them together and bridges the gap.

The ARC PSP has developed a form that shows the steps to take in developing a resilience project and the results that will indicate completion.

Table 2: Steps to be taken in developing a Resilience Project and the Results

Steps	Results
Community mapping and analysis of potential problems	A better understanding of the problem
Define goal	Clarity about what the community wants to achieve
Define objectives	Plan to achieve what the community wants to do
Define activities	Things that the community needs to perform among themselves
Identify people responsible	People that will be in charge of each activity
Resources	The community will know who will work, the materials needed, physical, and financial resources available and what the community needs to get.
Establish time lines	Time within which tasks/activities are completed
Follow-up	Make sure that all the specific tasks/activities are completed
Evaluation	Verify what the community has achieved

Agreeing on the strategy involves determining all inputs needed to implement the project, defining responsibilities of different groups or individuals, and specifying roles that they will play in the project.   

A mechanism for resultant progress toward objectives and feedback on activities should also be developed. This may involve participatory assessment meetings in which monitoring data are discussed and further action plans are elaborated.

B.  Sharing the Good News

The completion of the resilience project must be shared with the participants, the community, and the support agency. The implementation and organization of the community celebrations involve hard work and are important and vital parts of the mobilization. For the community, a celebration is an exciting break from the monotony of work or study. Drumming, dancing, plays, skits, parades, talent shows, and other modes of entertainment should be included in every celebration. Invite local amateur culture groups and school groups to perform. The celebration is a turning point for the community. They recognize that they are victorious in accomplishing their project.  This single step significantly contributes to the community recognizing its psychosocial competence.

4.4.  Supporting Host Government Capacity to Implement Psychosocial   

        Support Programs

In collaborating closely with the affected country’s government at different levels, the psychosocial programs can gain institutional acceptance and sustainability. In the immediate aftermath of a disaster, American Red Cross Psychosocial Support Programs, as a matter of policy, promptly begin coordination efforts with government and non-government groups. The coordination groups usually have representation from key government ministries such as the ministries of health, social welfare and education; UN agencies, and national and international non-governmental organizations.

The National Societies act as auxiliaries to the public authorities of their own countries in the humanitarian field. In most cases, the National Societies encourage the American Red Cross to participate in tripartite programs with key government ministries. This is an important element not only with ministries but also National Universities that the National Societies have worked with on PSP.

The services offered by ARC include capacity-building, material development and sharing, or purchasing of books and periodicals on psychosocial support activities and interventions. This activity has high impact, wide reach, high visibility, and because it is co-sponsored by the government, high acceptance from the public. 

5.0. Achieving Psychosocial Competence

An emerging sector in the realm of public health is psychosocial support.  Establishing healthy places is one of the objectives of a psychosocial support program after a disaster. To achieve psychosocial competence there are individual and community behaviors that have been observed during the tsunami recovery process. At the individual level, the survivor moves from the initial perception of risk and benefits, identifies healthy actions that will increase the benefits, explores some of these behaviors, and eventually is able to identify a menu of behaviors that lead to psychosocial competence.

To establish community psychosocial competence, the survivors talk to each other about what has just happened to them, and in doing so, develop inter-relationships that may in a short period of time, become a social support network. The survivors attend to urgent needs, responsibility for neighbors increases, and decisions to toward psychosocial needs are made. The individual and collective interactions lead to community mapping, examination of protective factors, shared objectives and activities. Survivors form themselves into a group that can direct change.  These individual and collective activities result in development of psychosocial competence.

6.0.  Summary

Psychosocial support is recognized as an important component of recovery and reconstruction efforts in communities in the aftermath of disasters. The forms and methods of such support have grown in response to the severity of disasters and have been refined to suit specific local needs. Community resilience projects or the reestablishment of ‘sense of place’ is a form of empowerment of the community to move ahead. Empowerment involves identifying healthy behaviors and practice of these behaviors results in the community networks directing change.   For sustainable reconstruction efforts, the community is the entity that makes choices about what needs to be done for rebuilding life. 

The key to success in disaster rehabilitation is to ensure that the people affected are involved in the planning and implementation of recovery programs from day one, based on an open dialogue and a strong partnership between communities and humanitarian assistance agencies. The Psychosocial Support Program, described above, assists community members to build on their own strengths, and develop their own capacities to mourn losses, celebrate the new beginning, and rebuild a new community. The surviving population emerge as victors from being victims, thus enhancing community competence, which is the ultimate goal of psychosocial support programs.

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