Recovery begins in the Shelters

RECOVERY BEGINS IN THE SHELTER

A recent report entitled “Resilience in the wake of Superstorm Sandy” (2013) produced by the Associated Press and NORC provides some insights regarding recovery after a major catastrophe. There are some insights that we should consider in developing strategies for recovery:

1.        Sandy generated extensive impacts beyond the physical damage, including prolonged effects on daily living and social relationships.

2.        While stable communities (resource rich) saw altruistic behaviors amongst its neighbors that resulted in a more resilient community.   Communities that had diverse culturally and linguistic members, migrants, elderly, and people with limited financial resources (in other words functional disabled people with limited incomes) reported the challenges of secondary stressors in recovery. This means that this segment off the affected communities will be faced with similar situations in the future.

3.        Some of the challenges faced by the second groups above include: (1) school and child care closings, (2) longer commutes, (3) missed time at work and (4) the relocation of friends and neighbors. This cohort remained more time in shelter, although they turned to friends, family and neighbors for assistance.

4.        Only 4% of the respondents turned to the ARC for assistance (p.6).  First responders provided a lot of support in the first 14 days of the response. Longer-term faith based groups and relief organizations provided longer-term support.  This period was characterized by reports of looting or stealing and hoarding of food and water.

Action moving forward into recovery

1.      Initiate resilience activities in the shelters focusing of “Community group meetings” every evening that focus on challenges, solutions and sharing good news.

2.      ARC in conjunction with NVOAD and faith based organization develop a tool kit for neighbors as a preparation activity that focuses on Psychological First Aid and activities that generate calmness in adversity and reduces negative behaviors.  

3.      Over reliance in social media may not be the best for “low resource populations” low-tech methods should be identified and practiced in at risk communities.

4.      Psychosocial support activities that address secondary stressors should be defined and develop into a tool kit (no more than a trifold) in several languages.

How do we know this works

1.    All DAT teams and volunteer responders familiar with resilience tool kits.

2.    Preparedness activities are developed and practiced with faith based and community groups in ZIP codes with low SES, linguistically and culturally diverse populations and people with functional needs.

3.    Schools become the conduits for information to the communities.

4.    In the next major disaster the percentage of reports of looting, stealing, hoarding of food and water will be reduced to less than 10%.

5.    Finally, the majority of the people asked randomly, in the potentially affected ZIP codes, will respond that they feel safe and secure of their response in the event of a major disaster.

Psychosocial support paves the way for a new life

PSYCHOSOCIAL SUPPORT PAVES THE WAY FOR A NEW LIFE 

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 President and CEO of the Center on Psychosocial Support in Disasters. AlexandriaVA. He is the recipient of 2008 APA International Humanitarian Award.

Survivor centric strategies and nimble resileince in the recovery proceess after a disaster

Survivor centric strategies and nimble resilience in the recovery process after a disaster

Joseph O. Prewitt Diaz

This commentary is to share a vision from the other side of a prism of disaster recovery that up to now has been presented to the disaster affected people after Hurricane Sandy.  It is mid June 2013, to this day the New York Times, the Daily News and other major newspapers in the area are reporting in the hundreds of thousands people are still living in temporary shelters. The U.S. Congress didn’t approve disaster aid until January 28, 2013 (http://www.nytimes.com/2013/01/29/nyregion/congress-gives-final-approval-to-hurricane-sandy-aid.html?_r=0).

Disaster-affected people in New York and New Jersey, have suffered lack of basic needs, severe weather, and support system that were not familiar to them. In addition the attempt to offer assistance for secondary stressors were foreign to them. A mismatch between the people and the way of life in place versus the way the Federal Government has planned the recovery operations has increased the insecurities, distrust and the fear of being uprooted from their place.

The tug between the external organizations with pre-planned programs to assist disaster affected people and the meaning that the disaster affected people are giving to a changing strengths and meaning of place may be serving as a block to the rebuilding of the places within neighborhoods and communities (Noji, 2005). Place is important concept to understand how people recover from a disaster in a large urban center since most research on place has been conducted in urban centers (Giernyn, 2000).

Survivor centric consultation, decision making by the disaster affected people in the re-establishment of place, the use if nimble approaches to foster resilience through psychosocial support techniques (Hobfoll et al. (2007); Prewitt Diaz, 2008b) to address the secondary stressors are the basic strategies needed to resolve the grit lock to services in New York and New Jersey.

Place is the perception in time and place of built and natural space that is constructed through narratives, stories, and networks. Historical, cultural, social, ecological and physicals attributes  are torn and re-woven according to the attitudes and feelings of people that find themselves in the eye of the storms, the peripheral turbulence, or who have lost themselves in the winds of despair (Sullivan, Schuster, Kuehn, Doble & Morais; 2009). Place includes leaving and coming back, cultural identity with others in the place, family connections, or this is the only place they know. There is nowhere to go, there is no way out. The multigenerational families, that developed the place, disbanded, the economy has collapsed. The only thing that remains is hope.

Having been displaced the night of Hurricane Sandy meant that the disaster-affected person didn’t know where they were or what was their place. To have no place means that disaster affected people were lost. There may be a lot of nice people trying to keep you calm but deep inside you know your place is gone. What are the next steps ponders the disaster-affected person. There were no words of comfort that could alleviate the feeling of being lost, disappearing, loosing connections, living in constant vigilance and being driven and governed by fear.

Prewitt Diaz & Dayal (2008) found with there work in the 2004 tsunami, that the key to meaning of recovery is found in place. The process of finding place is an inner and outer journey that fosters the capacity to locate place, give it meaning, and solidify the sense of belonging. Place holds the key to new beginnings. Place is the nature of a people joined together by their past and present, joined together by their aspirations for the future. The simplest explanation for what turns a group of people into a place is a shared narrative. Place is both a story and a history (Prewitt Diaz & Dayal 2008).

A nimble vision of resilience permits that homeostasis between built and natural environment in interaction with human beings may be the pathway to re-establish place. Defining as an end goal enhancing resilience provides an opportunity to disaster affected people to examine their place through mapping in its entirety, identifying the important elements of the place that enhance  resilience.

Psychosocial support provides a space for disaster-affected people to two specific phases (1) psychological first aid during the emergency phase. Psychological first aid 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 Manual, 2011, p. 335).  and (2) trains community workers to provide basic emotional and practical support to the disaster affected people in addressing the challenges of secondary stressors, by activating social networks, community trusted traditional support, and supporting age appropriate centers (SPHERE, 2011, p. 334).  The efforts of psychosocial support should be community based in that international guidance suggests: (1) enable community members including marginalized people to strengthen community self-help and social support, (2) as part of early recovery, initiate plans to develop a sustainable community by advocating for basic needs and activating community networks to provide practical support (MHPSS, 2007; SPHERE 2011).

Psychosocial support facilitates the development of social spaces that encourage and sustain a quality of interaction wherein people feel they can touch, shape and be shaped by accessible conversation. These suggest a combination of localness and proximity that helps people to stay in touch. In such places, people feel a sense of voice that reverberates and creates resonance with events and processes that affect their lives. These activities may reduce the feelings of uprootedness, alienation and placelessness (Fullilove;1996).

CRSI (2011) suggests that there are four steps that the community, place or neighborhood has to do to take charge of their own destinies: (1) an understanding of the meaning of resilience for the disaster affected people, (2) a practical measure of resilience in action, (3) simple usable tools and process that will help the disaster affected people to move forward and tangible benefit is that flow from their efforts. Resilience when applied to disaster-affected people is nimble. It is the quality of places that faces, moves, through and bounce back from difficulty, damage, or destructive experience with a spirit that pursues and stays in touch with purposeful life.

This commentary describes how a psychosocial support approach can enhance the communication between those that support a survivor centric approach to recovery and the Government “fit all” methodologies. The paper proposes a systematic approach using place, resilience, and psychosocial support to achieve client centric solutions and develop nimble resilience. 

Sources available upon request.

Pssychosocial path to recovery after the Oklahoma City Tornadoes

Psychosocial path to recovery after the Oklahoma City Tornadoes

Joseph O. Prewitt Diaz[1]

Psychosocial refers to the emotional reaction of a person when they realize that they are experiencing an event for which they are not physically equipped to manage successfully. There are three central factors in psychosocial support: behavioral, spiritual and social. The behavioral part is usually addressed with behavioral health strategies (i.e. crisis intervention, counseling or psychological first aid). Spiritual care is often a component used to address death and destruction. The social component emerges after the immediate crisis and last for a longer period of time, and it usually alleviates the traumatic stress as a result of secondary stressors (i.e. returning to normalcy, re-establishment of place, reconstruction of neighborhood and homes, and assisting the recovery efforts in the community).

As I write this commentary there are search and rescue activities going on. We are not sure how hard the tornadoes hit, but we know there are some very specific actions that need to take place in the next days, weeks and months. Below are six essential steps:

·      Alleviate fear by facilitating linking with family, neighbors, community and friends.

·      Assure safety and security through satisfying basic needs, providing shelter, and initiate behavioral health and spiritual care activities that promote calmness.

·      Engage disaster affected people in conducting assessment of the affected area, focusing on prioritizing the need for natural and built structures that are needed to begin the recovery process (i.e. school, day care, hospital, senior center, churches, and community stores).

·      Disaster affected people identify their immediate needs and received assistance with temporary shelter, neighborhood cleanup campaigns, and defining steps in the recovery. This will provide guidance to external partners and interested people.

·      Promote Neighbor-to-Neighbor psychosocial support, and activities for children, the elderly and those with functional needs.

·      Take time to rest, through celebrations and information. At first of the little steps to recovery and later community wide celebrations, fairs, and other collaborative activities.

This is a time when the affected community needs external assistance, however in the coming days and weeks recovery should be people centric. Giving a voice at the decision making table to the affected neighbors will go a long way to enhancing resilience, and promoting physical, spiritual and psychological well being.

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[1] Dr. Prewitt Diaz (jprewittdiaz@gmail.com) has over 30 years of experience in community recovery post-disasters. He served as Senior Psychosocial Advisor for a major INGO during the recovery after the 2004 South Asia Tsunami, and was awarded the 2008 APA International Humanitarian Award. He is the CEO of the Center for Psychosocial Support in Disasters