Dr. Joseph O. Prewitt Diaz Ms. Sujata Bordoloi Dr. Sibananda Mishra Ms. Anjana Rajesh Dr. Satyabrata Dash Smt. Indrani Mishra
Community Based
Psychosocial Support Training for
Community Facilitators
Acknowledgements
This manual has been produced with technical and financial
con-tribution of the American Red Cross. The authors are responsible
for the views expressed herein. This Manual is an adaptation of
Salud Mental en el afronte de Desastres manual developed by
the Peruvian Red Cross with the financial support of the
Ofi-cina de Asistencia para Desastres en America Latina y el. The
original manuals used widely in the Americas have saved many
lives. We hope that this Manual will provide timely information
to community facilitators, field workers, and trainers so that
disasters may be dealt with in the community in an effective
and timely manner.
Community Based
Psychosocial Support Training for
Community Facilitators
The following people are acknowledged for the development of this manual:
Technical Lead:
Dr. Joseph. O. Prewitt. Diaz
Indian Adaptation
Ms. Sujata Bordoloi
Dr. Sibananda Mishra
Mrs. Anjana Rajesh
Dr. Satyabrata Dash
Smt. Indrani Mishra
Printing coordination: Ms. Mridu Rattan
Field testing for cultural applicability: Mr.S.C.Dakua,
(Orissa DMH/PC Programme)
Mr.Ranjan Mohanty
Mrs.Sunita Pradhan,
Mr.Snehal Shah
(Gujarat DMH/PC Programme)
Ms.Poonam Vyas,
Ms.Khyati Vajeria
VHAI Contribution:
Editing and Proofreading
Puja Sharma
Cover and Illustrations
Brajagopal Paul
Typesetting and Layout
Subhash Bhaskar
Printed at
VHAI Press
This manual is
dedicated to the
millions of people of
India who have
experienced crises and
have overcome their
grief and losses.
They have moved from
victims to victors.
The frequency of disasters such as road accidents, epidemics, droughts and floods has increased multifold. Many more people are suffering from injuries, disabilities, mental and physical diseases. This is a matter of great concern to the communities, whose social, economic, and health status get seriously disturbed.
India is particularly prone to disasters. Its vastness, its ecological system, its geographical position makes it vulnerable to natural and human made disasters. Year after year people are subjected to intense suffering and immense losses. The poor bear the brunt of it. No one is spared.
Seeing the intensity of devastation and impact on the mental and physical well being of the survivors, the American Red Cross Society has developed a program to prepare communities to emotionally respond to and deal with the disasters.
To ensure the recovery of physical, emotional and psychological health, special emphasis has been laid upon disaster mental health and psychosocial care.
The focus of the training modules is on the disaster survivors and vulnerable groups who are geographically situated in disaster prone areas, or who are likely to be more affected because of the age group they belong to e.g. the elderly or the very young. The training will further help already existing community, leaders and volunteers to deal with these situations better. It is also for the benefit of any member of the community who might have to take on sudden responsibilities when faced with disaster.
Introduction
and
Purpose
of
Training
The methodology used in the modules is participative and interactive, with more emphasis on brainstorming, group work, role plays and the workshop method rather than lectures and presentations. Energizers are activities to recharge the group when they might be tired or losing concentration. Procedures are given as guidelines for conducting each of the activities.
Evaluation of the participants’ performance is based upon the pre test at the beginning and post test at the end of each module. The evaluation will measure: a) the extent to which the participant has imbibed the information and knowledge
on the topic
b) the effectiveness of each module and how far the objectives have been achieved. Group dynamics and motivation are integral to the modules. This encourages discussion and leads to interaction between participants on the one hand, and the facilitator and the community on the other.
Total duration of training programme = 56 hours Modules I,II & III should be covered in Phase I
Models IV,V & VI could be spaced out over 2 months. This would ensure better absorption of the knowledge and a good understanding of the procedures to be followed. Allocation of time is flexible – as per the requirements of the group and the instructor.
Introduction
to
Training
Programme
Training
Programme
for
Community
Facilitators
Goal
Enhance the capacity of community leaders, volunteers and members to carry out community based disaster mental health and psychosocial support activities.
Objectives :
• Introduction to the Red Cross Movement and the Sphere Standards of mental and social health underlining the minimum quality of service to be rendered.
• Facilitate the leadership and communication skills for the community facilitator. • Describe the activities that define Psychosocial Support.
• Develop methods to promote community based Psychosocial Support before, during and after a disaster.
• Facilitate the capacity of communities to carry out resilience activities. • Teach basic skills to deliver psychological first aid.
• Elaborate the basic methods of teaching.
Outputs:
At the end of the training, the participants will be able to:
• Identify and illustrate five qualities that describe a situational leader and a community facilitator.
• Explain at least five characteristics that are common to every disaster and five common responses to disaster.
• Illustrate at least two activities, each, that describes Psychosocial Support. • Conduct a community needs assessment (find out the protective and risk factors
and prepare a vulnerability map of the community).
• Develop at least three tools (trifold, drama and song) and prepare materials for promotion of disaster mental health in the community.
• Identify and carry out at least three Psychosocial Support activities in the community.
• Enumerate at least five principles of psychological first aid. • Deliver the five steps of psychological first aid.
TABLE OF CONTENTS:
MODULE I: ROLE OF A COMMUNITY FACILITATOR………...
1. Communities and groups……… 2. Who is a leader ?……… 3. The community facilitator……… 4. Conflict and conflict resolution……… 5. Communication………. Annex 1.1……… Annex 1.2……… Annex 1.3……… Annex 1.4………
MODULE II: PSYCHOSOCIAL SUPPORT IN DISASTERS .……….
1. What is a disaster ?………
2. Disaster Mental Health and Psychosocial Support………
3. Common reactions to disasters………
4. Mental Health in the community………
5. Prevention in Mental Health………
Annex 2.1. ……… Annex 2.2………
MODULE III:PROMOTION of PSYCHOSOCIAL SUPPORT………
1. Promotion of mental health in disasters………
2. Strategies of promotion………
3. Guidelines for promotion………
4. Types of communication material………
Annex 3.1……… Annex 3.2……… Annex 3.3………
MODULE IV: COMMUNITY BASED PREVENTIVE ……… DISASTER MENTAL HEALTH/PCYSHOSOCIAL SUPPORT ACTIVITIES
1. Tools for community organization……… 2. Psychosocial support and care activities……… 3. Stress management and self-care techniques……… Annex 4.1……… Annex 4.2………
MODULE V: PSYCHOLOGICAL FIRST AID………..
2. The concept of distress and stress……… 3. Importance on Non-verbal Communication………
4. Implementation of PFA………
5. The Organization of Emotional Brigade………. Annex 5.1……… Annex 5.2………
MODULE VI: TEACHING METHODS……….
1. Information………
2. Training and Information………..
3. Management of a classroom………...
4. Elaboration of lesson plan………..
5. How to elaborate visual aids………
6. How to use our own visual aids………..
7. Methods of a training………
8. Furniture and equipment………..
9. Method of evaluation………
Annex 6.1……… Annex 6.2………
Objective:
To show how leadership and effective communication are the most important tools for the community facilitator.
Expected Outcome:
The participants will be able to: • Work in and manage groups.• Identify and illustrate at least five qualities that describe a community facilitator and a situational leader.
• Illustrate and execute at least two activities that a community facilitator can carry out in the community.
• Acquire basic skills in communication.
1
The Role of A
Community
Facilitator
Give a general background of the Red Cross, its origin, its principles and its various activities. Talk of the Sphere Standard of mental and social aspects of health underlining that a minimum standard in the quality of service is to be maintained. And emphasizing that accountability is a must.
Then move on to
• define groups, community and community participation.
• describe the role of the community facilitator with two activities that he/she can perform in the community.
• define situational leadership and give two characteristics.
• demonstrate the most effective methods of communication while working with groups and individuals.
Pre Test (Annex 1.1)
Activity 1
This deals with establishing contact with people and retaining that contact information.
Ask a participant to give his/her name. Tell the next person to repeat that name and add on his/hers. This chain of names, each one adding on theirs to the list, must carry on till the last participant. How much a person can recall, will be an indication as to what extent we listen, retain and remember our social contacts.
l. Communities and Groups:
l.l What is Group ?
A Group consists of three or more people who get together and work together for a period of time, for a common reason. People get together because of similar interests, customs and regional backgrounds.
People in a group
• share interests and goals.
• have certain rules and regulations that they abide by. • participate in activities to strengthen the bonds.
Introduction
• work towards common goals which in turn support the individual Groups. Are ever changing and have dynamic interactions. For example, the personal relationships between each member affect the overall interaction in the group, as well as its functions. These relationships change over time.
Groups can be of different kinds and can be based on:
• Gender – Men and women • Age - Elderly, adolescents, children
• Religious – Muslims, Hindus, Christians
• Social - Family, friends, neighbours, co-workers
Activity 2:
On formation of Groups. Distribute one card to each participant. Divide the participants having similar cards, in pairs. Five minutes will be given to the pairs to get to know each other. Then, one of the pair will introduce the other. Similarities and common interests will be discussed. This will be the basis for forming the groups.
Brainstorm on Groups
(Refer to handbook module-1 Q. No.1 Jamila , Venu)
1.2 What is a Community?
A community consists of a number of groups of people, living in a particular locality, sharing common interests, traditions, language and lifestyle, interacting with each other and participating as a homogenous unit.
Activity 3:
Brainstorm on community
What do you understand by a community?
What are the main characteristics of a community? What does your community look like?
1.3 What is Community Participation?
Community participation is the way in which each member in a group or community takes part in decision making related to his/her community. The groups work together in achieving common goals for the development of the community and individuals.
E.g., Members from different groups can form a local village committee to assess the psychological or social needs in the village and plan activities that can meet those needs.
Activity 4:
On the importance of community participation:
The participants will stand in a circle with sufficient space between each other. Their task is to pass a glass around. After the glass has been passed on to the last person, the facilitator will instruct one participant to go out from the circle. The remaining participants are to continue the exercise without shifting position. It will now be difficult to carry on because of the absence of one member’s participation.
GROUP DISCUSSION on Community participation
(Refer to handbook module 1 Q. No. 3 Football Match)
2. Who is a Leader ?
A leader is a person, who has the ability to show the way, has the interest and capacity to help others and is accepted voluntarily by the people.
Each community chooses their leader according to their own yardsticks and in the best interest of the community at large.
Activity 5:
On the definition of a leader :
One of the participants will be blindfolded with a handkerchief. Some objects like books, chairs and bags will be kept on the ground of the training hall as obstacles. Then, another participant will be asked to give directions to help the blindfolded person walk through the hall without touching anything on the ground.
Brainstorm on qualities of a leader Guidelines to discussion:
Who is a leader?
Identify some persons in your community who you think are leaders. What qualities in them make leaders?
2.l QUALITIES OF A LEADER :
Certain characteristics in an individual make him/her more acceptable as a leader .These characteristics make members of a group/s more willing to be guided by him/her in decision-making processes.
• For example, what made the nation accept Mahatma Gandhi as their leader during the freedom struggle? It was perhaps the way in which he was able to represent the needs of the nation and take decisions after considering everyone’s views and opinions.
A good leader will be capable of:
• Being a role model.
• Adjusting in different situations.
• Making people share their experiences and contribute. • Capable of dealing with the expectations of others.
Here are some of the roles a leader must play:
• Listener • Motivator
• Initiator– taking initiative in beginning new processes • Decision-maker
• Observer – encourage people according to their skills and capabilities • Advisor
• Communicator • Friend
• Advocate
(Refer to handbook module 1 Q.No.4 Anand)
2.2 WHAT IS SITUATIONAL LEADERSHIP?
Situational leadership is:• The ability to take charge in an emergency, crisis or difficult situation.
• By adopting a style that builds on the positive strength and abilities of people affected
• By observing and determining the needs of the situation at hand. Situational leadership requires:
a) The skill to handle the situation
b) The will to take up the work at hand and be accountable .
Situational leaders are individuals who have the maturity to assign tasks and
undertake responsibility in certain situations, which demand immediate action or response.
E.g. In a disaster situation some members in the community take the responsibility to carry out assessments - of the numbers injured or dead, nature and magnitude of losses suffered. They also ensure that relief material, medical facilities reach the people. These people become situational leaders because the community readily accepts them. They have also shown the ability to respond to a situation, responsibly and with care.
Elements of situational leadership: The person should have the ability to • Take responsibility.
• Communicate with different groups.
Activity 6:
Rope Game on tackling a problem situation. A pair of participant will have their
hands tied by a rope in a difficult knot. They have to somehow open the knots. Other participants can suggest different ways to do so. The ‘knotted pair’ must decide and act on the instructions. It is to be seen that whose advice will enable them to successfully untie themselves?
Conclude on Situational leadership.
Lecture & Brainstorm on Situational leadership
(Refer to handbook module 1 Q. No. 5 On flood/fire)
3. THE COMMUNITY FACILITATOR
3.l WHO IS A COMMUNITY FACILITATOR ?
This is a person who, keeping the interests of a community or village in mind and is capable of initiating action for the welfare and protection of all. Special emphasis is given to psychosocial support by way of promotional and preventive activities on mental health. This equips the community to deal with disaster situations better. An efficient community facilitator should have the skills and ability to work in collaboration with the institutions in the community, for example the doctors, nurses and Auxiliary Nurse Midwife (ANM) at the Primary Health Center (PHC) and the Aanganwadi (community) workers, teachers and Balwadi (primary school) workers at the school level.
Activity 7:
BRAINSTORM on Community Facilitator Guidelines for discussion:
What qualities should the community facilitator have? What are his/her roles?
How can we identify a community facilitator?
What methods can be used to identify or involve a community facilitator in DMH/PC activities?
A Community facilitator must be:
• person from the community affected by or at risk in disasters. • experienced in working with the community.
• recognized and trusted by the community.
• sensitive to the beliefs and traditions of the community. • with spirit of voluntary service.
• leadership capability. • communications skill. • open to new ideas.
• basic knowledge of mental health and disasters.
The Community Facilitator has the abilities and skills for:
• Communication.
• Vulnerability and Community mapping. • Community Organization
• Conducting of group meetings.
• Dissemination of educational material.
The Community Facilitator has knowledge of:
• The contents of the mental health training modules and mental health intervention programmes for people at risk or affected by disasters.
• Knows how to conduct community mapping and develop physical and emotional assessment among different groups in the community.
3.2 COMMUNITY FACILITATOR’S ROLE IN GROUPS
(Refer Annex 1.4):
The community facilitator has the responsibility of bringing different groups in a community together. He/she has to be able to represent the interests and needs concerned with the mental health and psychosocial support of each group. In this process, the community facilitator will become part of forming and organizing group meetings.
The specific tasks community facilitator has to perform are:
• ensure that the participants are clear about what they want to achieve.
• direct and stimulate teamwork and emphasize the strength of collective action. • foster a trusting and friendly environment with respect to individual privacy and
confidentiality.
• see that the agenda is followed and that members do not get diverted from the main topic.
• encourage members who are not very participative.
• control and maintain order and the norms decided on by the group. • direct the meetings towards reaching conclusions and commitments.
Activity 8:
Community facilitator’s role in groups :
The participants are divided into two groups, each representing the community of two neighbouring villages. Four participants are made to stand in the center holding hands to form a square. This represents a pond. One participant takes on the role of a facilitator. Two ropes are given to the groups. They are to mark the boundary of their villages. They both try to include the pond in their territory. There is pressure from both sides on the four in the center, causing them to go off balance. Facilitator steps in to discuss how both the sides can enjoy the benefits of the pond.
[Refer to handbook module 1 Q.No. 6 ( A & B), Q. No. 7 ( A & B ).]
3.3 Other Responsibilities of the Community
Facilitator
The community facilitator promotes and leads mental health programmes in his/her community. He/she is responsible for all individual and group level activities. ( refer Annex.1.3)
4. Conflict and Conflict Resolution
What is conflict?
It is the quarrel and clash of interests, differences of opinion or lack of understanding between two or more people. Conflict often occurs when people are trying to work towards some common goals. The community facilitator should be aware of the possibility of conflicts when he/she is working with groups.
Very often, differences of opinion with other people, with friends, even with members of our own family arise in our daily lives; therefore it is important to learn how to identify the conflicts, manage and resolve them in order to improve our social, personal and family relationships.
Conflicts are not easy to solve due to the difficulties, complexities and variations in the interpretations of ideas, concepts, way of thinking, customs and behaviour.
Conflict arises when:
• We do not recognize what another person is experiencing and how he/she is responding to a situation.
• Our effort to be supportive is perceived as inappropriate. And when there is.:
• Difficulty in communication leading to misunderstandings. • Absence of dialogue.
• Excessive aggression. • Dishonesty.
Conflicts are caused due to misunderstandings, which go out of control, and people are not able to differentiate between reality and their own perceptions of the situation. In India, many caste confrontations are caused due to minor events, which develop into violent situations due to misunderstandings, rumours, prejudice and wrong perception.
Activity 9:
Role play, put an end to conflict:
Make three or four groups of participants.
Give a proposal to install a tube well in a community.
Each group has to give their own suggestions about a suitable place in the village for tube well installation.
Brainstorm: On conflict (conclude on conflict resolution)
Guidelines for Group discussion:
Have you ever had a fight or disagreement with someone? What was the issue? Have you ever helped someone resolve a fight/disagreement with another person? What are the reasons for disagreements?
What reasons do you see for disagreements to arise in the community?
Sharing of experiences during the discussion
How can we resolve conflict?
• Accept the person. You don’t have to accept the behaviour.
• Correct inappropriate behaviour before it becomes a trend in the interaction. • Express your feelings if you are uncomfortable with a person’s behaviour.
To avoid conflict, we must:
• Understand feelings
Be in another person’s shoes and try to see his/her viewpoint.
• Be sure of oneself
Say what you think or feel without hurting the other person.
• Be able to adjust with different situations and people
Be tolerant, sympathetic, friendly, forgiving, impartial and supportive.
• Know your faults and virtues
Be aware, that each one has his/her own ideas and thoughts, and accept our mistake acknowledging the fact that we are not perfect. This helps in changing our behaviour for the better.
• Be polite
The pleasant and friendly approach helps us make friends.
[Refer to handbook module 1 Q.No. 8 ( A , B & C)]
5. Communication
We exchange spoken and written words, facial expressions, gestures, body postures and tone of voice Communication is a method by which channels of interaction are opened between people.
Activity 10:
EXERCISE: Non – verbal communication
Four participants are selected. They are given four different cards with four different emotions written on them e.g. happiness, sadness, anger, jealousy. Then each one is asked to demonstrate the emotions respectively. After the participants finish, the group is asked to guess who enacted what, and how they recognized the emotions.
Message conveyed –
The importance of Non-verbal gestures in communication and the importance of response through keen observation.
Communication comprises three important aspects:
• Seeing/Observing: The person’s body language, eyes, way of speaking etc. • Listening: To what the person is trying to tell you and responding accordingly. • Making physical contact (when appropriate): Making contact with the person. It
can be a pat on the back, a hug, and slight touch of hand etc.
Components of communication:
• We are always communicating verbally or non-verbally. While dealing with others we communicate by speaking as well as by remaining silent.
• Our body posture and gestures will help us to communicate better. Non-verbal cues give out subtle messages, which may or may not be intended.
• Communication has content and relationship; the content is what we say, the relationship is the way we say it. For example, “I agree on participating in the meeting, but I do not like the way that some people talk to me.”
• Communication can be positive in giving positive feedback rather than negative, and by making positive reinforcements in public and in private. It should foster collaboration that allows people to work together and combine skills and resources.
• It is important, that our communication is clear and precise. Although sometimes it is difficult to communicate what we actually want to express due to fear, habit and tradition.
• Communication encouraging the positive aspect of a negative experience (e.g. possibility of a productive life ahead) is always more helpful to a disaster survivor instead of over-emphasizing the fact that he/she is a disaster survivor.
5.1. Verbal and Non-verbal communication:
The way, we send messages through our eyes, hands and body movements along with what we speak is called verbal and non-verbal Communication.
Certain body signs also communicate certain things about a person. Thus, what we say is as important as how we behave because our actions also send out subtle messages to the person we are trying to communicate with.
For example:
a) Not maintaining eye contact during conversation indicates that the person is not interested or is thinking about something else.
b) Touching the lips, looking upward, head lowered towards the chest indicates that the person is in a reflective mood.
c) Red face, high tone of voice, pointing with finger, arms and legs crossed, forehead wrinkled indicates that the person is irritated or very angry.
These are some general examples, but different individuals have different ways of telling each other their state of mind. People, who are close, like two good friends or husband and wife, are able to guess when the other is in a bad mood, through their body language.
Similarly, when two people do not know each other and meet for the first time, body language helps them to develop better understanding of each other along with the spoken words exchanged.
5.2 Listening and responding
Characteristics of a good listener:
• Listens to each word carefully.
• Listens and look for the feelings and basic assumptions underlying the remarks. • Good listener does not interrupt, especially to correct mistakes or make points. • Doesn’t judge.
• Mainly ask open-ended questions. E.g. “So how are you feeling today? How was your day?”
• Interprets the total message through words, body language and facial expressions.
• Pays attention to the message.
• Is careful with what you are saying as words can often be a source of misunderstanding.
• Encourages the person to express all his/her ideas without repressing him/ herself.
This module is focused on providing guidelines for the community facilitator in terms of the skills requires and of his/her role in community. It emphasizes the importance of leadership and communication in bringing about community participation among different individuals and groups. It also attempts to increase the knowledge of the community facilitator about Red Cross and the Sphere standard of mental and social aspects of health. Although the community facilitator’s role is a dynamic one, it is broadly outlined in this module thus enabling him/her to have better understanding of his/her responsibilities.
The following module provides the basic concepts of Disaster Mental Health and Psychosocial Care (DMH/PC) to enable the community facilitator to understand his/ her work in the community. It provides him/her skills to carry out needs assessment in the community from a DMH/PC perspective.
Post Test
Annex 1.1
Module 1:
The Role of a
Community
Facilitator
PRE/POST EVALUATION
Name:____________________________________________Date: ______________ Institute/organization to which he/she belongs:____________________________ Place:_______________________________________________________________Indicate the correct answer with a tick mark (√)
1. Role of a leader:
a. To make all the decisions.
b. Not to interfere in the group process. c. To force the group members to participate.
d. To identify skills and maturity in the group members.
2. Communication means:
a. Sharing of experiences. b. Speaking and listening.
c. Using verbal and non-verbal language. d. Letting the other person talk.
3. The community facilitator is:
a. The sarpanch in a village.
b. A trusted person who understands the village. c. A person who can work in groups.
d. A red cross volunteer.
4. Verbal and non-verbal language involves:
a. Active listening and responding.
b. Communicating through words, and body movements, eyes and expressions. c. Talking to people.
d. Remaining silent when talking to someone.
5. A community is:
a. Two or more people
b. Groups having common factors. c. Sharing, participation and fellowship. d. All of the above.
6. Two principles of Red cross are:
a. Tolerance b. Helping others c. Humanity d. Neutrality
7. The Sphere Standard of mental and social aspects of health refers to people having access to
a. A minimum package of services to prevent transmission of HIV/AIDS. b. appropriate services for the management of injuries.
Annex 1.2
Steps for participative planning:
1. Take opinions of groups in the community on common problems and possible solutions.
2. Participative planning helps to make action plans for the community. The planning is done after discussions between different groups in the community who are present and who have made their priorities clear.
It Involves:
1. Identifying the main problem: Here members of different groups get involved in discussing the problems faced by the community. The main goal is to decide an approach to solve this problem.
2. Proposing alternative solutions: This allows the organization to discuss the alternatives solutions to address the problem. These are the objectives, which will help to fulfill the goal.
3. Identifying the resources: This includes making a list of the various things that exist in the community, which can be used. The resources are material, physical, human or financial.
4. Describing the activities: This involves planning the specific actions, which will be used to fulfill each objective.
5. Allocation of responsibilities: This includes deciding the people who will be responsible for fulfilling the tasks.
6. Deciding the time period: This involves deciding the period within which the planned activities are to be completed. This is a very important component of the action plan.
For Example:
A Community Action Plan
STEPS RESULTS
1. Diagnosis and analysis of the problem: Distressed
children in the community after a disaster. We will understand the problem better. 2. Define goals: Care and support for children
after a disaster.
We will be clear about what we want to achieve.
3.Define objectives:
1. Selection of children and families who have been severely affected.
2. To improve the family atmosphere through different interventions with attention on psychosocial support and mental health.
Clarity of path, to achieve what we plan to.
4. Define activities: Organizing picnics and
drawing for children. Things/tasks that we need to do amongst us. 5. People responsible: The Aanganwadi worker or
the teacher. People who will be in charge of each activity.
6. Resources:
1. The contribution of the community to organise the picnic.
2. The premises for the picnic.
3. Pens, paper, pencils, crayons for the drawing.
We know who will work, physical and financial resources available and what we need to do to get them.
7. Establish time-lines:
1. Picnics in the month of May 2003
Timeframe within which tasks/activities must be completed.
8. Follow up: Meeting the children every week in the school building.
Make sure that all the specified tasks/activities are completed.
9. Evaluation: Ask the children what they felt
Annex 1.3
How a community facilitator can fulfill his/her
objectives…
A. ASK THESE QUESTIONS:
1. What are the problems of individuals in the area I work ?
2. What are the problems of the community in the area where I work ? 3. What are the efforts made by me during my fieldwork ?
4. What are the problems faced by me ? 5. Who are the people I am able to help ? 6. Who are the people I am unable to help ?
7. Who are the people I have referred to various agencies?
B. Write a detailed illustration of your field experience in the month.
For example,
I worked with ……….people this month.
I helped………people through my experience and knowledge. The community needs are:
……… ……… ……… I feel satisfied with my work this month because…...
Annex 1.4
You might have these problems when working in
groups:
1. What to do, when people do not participate ?
If there is lack of attention is from a participant who is causing disturbance to the rest of the people, wait till there is a break or till the work session ends before you speak to this participant in private. Ask him/her calmly and in a friendly manner so that the person is honest with you.
If the lack of attention is disturbing the whole group, you can ask the person politely for an explanation in front of the group.
2. What to do when the whole group is not participating?
It could mean that the way you are facilitating is boring or tiring or the activities are too complicated or simple. To prevent this, we recommend that you plan activities that have movement, which are of the level of the group, which lead to healthy discussion without hurting anyone’s feeling or humiliating people.
It is also suggested that at the beginning of each session, you present the topics you plan to discuss and the activities.
3. What to do when the group ‘attacks’ you ?
To avoid this situation it is best to clarify in the beginning that the entire group is responsible for the success or failure of the group. If the group expresses dissatisfaction:
• Allow them to express their frustration, anger, and disillusionment.
• Try to direct the problem away from personal attacks and focus on the problem the group decided to meet for.
• Guide discussions towards finding solutions.
4. What to do when there is not enough time to do all that you had planned?
If our work agenda is longer than the time available:
Establish an order of importance. We will deal with the most important and necessary items first and if there is time left we will work on the other points.
Have two or more meetings to work on a topic.
Once the agenda is adjusted to the time available, right at the beginning of the meeting ask someone in the group to take the responsibility of controlling the time. It is possible that while you are working, you are so busy or involved in directing the group that you may forget the time you have for each activity. This person will remind you, in case it is necessary, about the time you have available for the activity that you are doing. This does not mean that the person will not
participate in the group activity. Tell the group when the time limit established for each activity has been reached or passed and ask whether they want to continue or stop.
5. What to do when opinions are different and they end in battle about ‘who is right’ ?
Focus the discussion on the problem at hand and its effect on the group and not on one individual.
Remain neutral. Don’t take sides.
Stop the discussion. Ask questions to each of the parties and ask them to clarify their doubts or problems.
Remind the group that they should remain neutral and respect the opinion of each member and listen carefully.
Let each member share what he or she understood of the problem and their suggestions for resolving it.
6. What to do when an exercise or an activity fails?
This could be due to any of the following reasons:
• When the activity does not take place the way it was planned.
• When it takes place as planned but the group destroys the meaning of the entire activity.
What to do?
• Admit in front of the group that the activity has failed.
• Identify with the group that what were the causes leading to the failure of the activity and thus, avoid a future failure, for e.g., clear instructions were not given, we didn’t want to participate because it seemed silly to us etc.
Session Guidelines to Module- I
CONTENTS ACTIVITY SOURCES DURATION
Introduction about Red Cross and Sphere Standard of mental and social aspects of health. Introduction to Module- l WELCOME Participants Introduction(Remembering the name) Presentation and Brainstorm Presentation of module- l Activity 1 Paper, pencil, folders. 15 mins 30 mins 10 mins
PRE TEST Annex 1.1 20 mins 1. Communities and groups.
2.2 What is a group ? 2.3 What is community ?
2.4 What is community participation?
Exercise: Introduction with playing cards – similarity in each pair. (Conclude on groups)
Brainstorm: Groups Brainstorm: Community Exercise: Passing the Glass Group discussion: Community Participation Activity 2 Activity 3 20 mins 15 mins 15 mins 30 mins 2. Who is a leader ? 2.5 Qualities of a leader
2.2. What is situational leadership?
Exercise : Helping blind men (Conclude
Definition)
Brainstorm : Qualities Exercise : Rope game-Leader to help (Conclude) Lecture Activity 4 Activity 5 20 mins 20 mins 15 mins 10 mins 3. The community facilitator.
2.6 Who is a community facilitator? 2.7 Community facilitator’s role in
groups.
2.8 Other responsibilities of the community facilitator
Brainstorm Lecture
Activity 6 60 mins 40 mins
4. Conflict and Conflict resolution.
Exercise: Role play Tube well (conclude On conflict)
Brainstorm: on conflict Group discussion :
On conflict resolution (conclude)
Activity 7 60 mins 5. Communication.
5.1.. Verbal and non-verbal communication
5.2 Listening and responding 5.3 Sharing thoughts : Feedback & disclosure Lecture Brainstorm: Brainstorm: Activity 8 30 mins 30 mins 30 mins
POST TEST Annex 1.1 20 mins
Objective:
Increase the Community Facilitator’s knowledge of Psychosocial Support.
Expected Outcome:
The Community facilitator will be able to identify:
• five common factors and common responses to every disaster
• three factors that define psychosocial support
• five protective and risk factors in the community and
• prepare community map of the affected community.
2
Psychosocial
Support in
Disasters
Describe a disaster. Discuss common reactions to it. Move on to talking about Psychosocial Support with examples. Identify protective and risk factors in the community. Develop a map of an affected community with these points in mind. PRE TEST (Annex 2.1)
1. What is disaster?
A disaster is an occurrence disrupting normal conditions of existence and causing a level of suffering that exceeds the capacity of adjustment of the community. A disaster is an event that:
• is beyond the community’s capacity to respond,
• affects humanity with loss of life, livelihood and property, illness and injury, • destroys social structures like offices, schools, road links,
• brings about scarcity in essential needs such as food, shelter, clothing, medicines.
Eg. Gujarat earthquake.
Activity 1:
Brainstorm on disasters.
What do you understand by a disaster? What happens? Why? Have you experienced any? Is your village prone to disasters?
1.1 Types of Disasters
Disasters are either natural or human-made.Natural disasters are caused by natural forces. They come without warning. They are often unexpected and unavoidable. Earthquakes, cyclones, hurricanes, volcanic eruptions are natural disasters. They cannot be controlled. But floods, droughts, landslides can be avoided or reduced by civil works such as dams, planting of trees and also by disaster preparedness planning.
Human made disasters are caused by human neglect or carelessness. They too are unexpected. They can cause great damage to life and property. Sometimes they have long lasting psychological and physical effects. Accidents, fires, blasts, pollution, wars, riots are some examples.
Natural Disasters Human made disasters
Floods Riots
Earthquakes Wars
Landslides Industrial accidents
Droughts Accidents (road, rail)
Cyclones Terrorism
Storms
Hurricanes
Activity 2:
Make a few cards with the various disasters written on them. Distribute these cards among the participants. Tell them to identify whether they are natural or human-made disasters.
Brainstorm on types of disasters
1.2. Phases of Disaster:
Event: is when the disaster is taking place.
Response: is when relief and rescue operations are on.
Rehabilitation is the time taken to complete the task of rebuilding community’s confidence, returning of survivors to their homes or finding new homes if the former are destroyed.
Reconstruction: is the period when people are helped to organise themselves for the prevention of such disasters, equipping them with well-planned preparedness. Prevention and mitigation: is the long term process of strengthening the existing protective factors and lessening the risk factors in the community and the area concerned.
Activity 3:
On Community response to disaster
Except for one, all participants stand in a circle with their hands held above. The person left out comes and pushes one participant from the back. This results in some or all of them falling. Some stay down. Others get up with help. Each one responds differently. Some quick, some lethargic. Ultimately with help, all of them get back to their standing positions.
Activity 4:
This is to demonstrate community’s response to a warning.
Divide the participants into two groups. Place two ropes on the floor in between them to demarcate a river. The space on either side, between the river and the participants, is “land”. When the instructor calls out “river”, the participants are to jump into the ”river” area between the two ropes. When the instructor says, ”land”, the participants are to stand between the rope and their own positions ,which is “land. The instructor will give the orders and the participants are to follow them instantly. This will show the alertness of the participants and their capacity to react instantly. There will be confusion and fun, but the point will be well made.
Activity 5:
Check for preparedness.
Except one, all the participants are to join hands and form a circle. The one left out is to quietly slip into the centre of the circle without the others being aware. This will be brought to their notice. An outsider can get in only if they are not vigilant. Next time the outsider tries to enter the circle, he cannot. The hands forming the circle are held firm. They are prepared.
2. What is Psychosocial Support ?
Psychosocial Support is a program that prepares the community to be emotionally equipped to respond to disaster.
It includes support and care activities that bring the people of the community together and build a network between organizations that work in the area.
The duration of psychosocial support activities can be between four weeks and three years. It’s a long term process covering the rehabilitation and reconstruction phases.
Psychosocial Support Activities:
• Crisis Intervention: helping the survivors, cope with the problems caused by the unexpected crisis.
• Build Social networks: connecting all the social organizations within the community to share their ideas and knowledge for the benefit of all.
• Support Groups: to help survivors share their feelings, emotions, experiences. • Training: for volunteers and members of the community to carry out DMH
activities.
3.Common Reactions to Disasters:
Reactions to a disaster are normal reactions to an abnormal incident.
“Most disaster survivors are healthy people who fulfil the responsibilities and solve the problems of day-to –day living. However, a disaster event tends to disturb this fine balance and puts them through an emotional and psychosocial upheaval.”(Myers, 1994)
Activity 6:
On various reactions to disaster Cards with different reactions written on them are distributed to the participants. They have to identify which are the negative and which are the positive attitudes.
The common reactions to a disaster or crisis situation are :
• Shock, disbelief and denial - I can’t believe this is happening to me • Fear - I’m scared of the dark;
• Anger - Nobody’s doing anything for us • Confusion – I don’t know what to do.
• Guilt - If only I were at home then, I could have saved…. • Shame – I can’t beg for relief material
• Grief - All our joys have gone
• Disorientation – I don’t know where am I , who is this man and what time is now?
3.1 What is a Crisis?
A crisis is:
• A personal disaster.
• Anything which goes beyond a person’s coping capability at that given time. • It affects everyone.
• Has a different personal reaction.
• It could have a negative or positive outcome. It is very important to remain positive throughout and make the best of the situation.
3.2 What is Loss and Grief?
What is loss?
• It is the suffering caused by the permanent absence of someone or something very dear to us.
• There are three kinds of losses. Emotional, physical and material.
• Emotional Loss – Death of a loved one. Loss of faith (especially after riots/wars),
identity, trust, hope.
• Physical Loss – Loss of limbs, physical ability, memory, physical appearance
(because of severe injuries, burns).
• Material Loss - Loss of property, money, home.
What is Grief ?
• It is a combination of sadness, fear, hopelessness and anger. • Grief brings on a change in everyone.
• While recovering from loss it is normal and healthy to grieve.
• Sharing memories and expressing feelings of sadness helps overcome grief.
3.3 What is Stress ?( Bryce 2001)
• It is the way the body responds to a situation that is different from a daily life situation. For example, organizing a marriage ceremony can cause sleepless nights for the family members.
• Stressor is the event that makes our body respond. For example a farmer is not able to sleep, eat, well or fulfill his daily chores because the rain is delayed. That is a stressor.
• His inability to sleep and eat is the way his body is responding.
• Stress is caused by constant worries in daily life. Where will the next meal come from? No money to buy food. The children are unwell. Stress can cause illness.
Here are some stress reactions
Behavioural
Sleeping problems, crying easily, avoiding remainders, feeling alone or social withdrawal, increased conflicts with family.
Affective (emotional)
Depression, irritability, fear, anxiety, hopelessness, guilt feelings,
self –doubt, changing mood frequently.
Somatic (Physical) Heavy sweating, headaches, loss of appetite, tiredness, pain in the muscles and chest, excessive activity level. Interpersonal Helplessness, withdrawal, difficulty in sharing, guilt seeking help from family and community members.
Cognitive Confusion, disorientation of place, person and time, nightmares-bad dreams, trouble concentration, difficulty in making decisions, preoccupation with disaster.
Activity 7:
On stress –an artist’s attempt
A participant is asked to draw on the board. Others are quietly instigated to disturb him/her with various suggestions. The artist can’t continue in peace. Gets stressed.
Brainstorm on stress
Activity 9:
Energiser
Three participants are chosen and given three cards –(1) has dog written on it,(2)cat, (3) lion. They are the leaders. The other participants are to choose any of these three numbers. They are grouped accordingly. Each group is made to stand in a different corner of the room. They are then asked to make the respective calls of the animals and reach their leader. This makes them stress free.
4. Mental Health in the Community
To promote community mental health, one has to identify the weaknesses in the community that may cause mental health problems and also strengthen the factors which will increase the capacity to respond positively.
4.1 Protective and Risk Factors
A community has certain physical and psychological factors which either makes it more vulnerable during disasters or more capable of handling the situation. The positive are the protective factors. The negative ones are the risk factors.
Protective Factors Risk Factors
These are the strengths in the community.
These are the weakness in the community.
The factors increase the community’s capability to respond physically and emotionally to a disaster or to recover from a disaster.
The factors make the community more vulnerable to a disaster and decrease its capability to adapt to its aftermaths.
Protective factors and risk factors can be identified by the
availability of the following information:
• Geographic location (distance from epicenter, open field canal) • Past experience (how well it has dealt with crisis situations before) • Communication infrastructure (Vehicles, roads, closeness to hospitals) • Social bonding in community ( Number of Self Help Groups)
• Community resources (Teachers, doctors, Aanganwadi workers)
Activity 10:
Group Work:
Participants are to be divided into groups. Each group will represent a village. They are to figure out their strengths and weaknesses, and present their case. The leader of each group (chosen by members) will make the presentation.
4.2 The Importance of Needs Assessment
(iden-tifying protective and risk factors)
• For the community to be aware of its strengths and weaknesses and prepare accordingly.
• For the community Facilitator to be able to work on the weaknesses and develop the strengths.
Methods to be used:
• Observation: Meet people of the community and identify vulnerable groups. • Interview: Personal contact on a one to one basis. Get to know them closely. • Individual surveys: Of the population in the area.
• Group surveys: Of the affected community.
• Reports: From government and non-government agencies who may have done prior assessment in the area.
Assessment of Post –Disaster Stress Reactions
You can ask these questions in one to one contact:
• Do you have trouble falling asleep ?
• Do you have repeated disturbing dreams about the event?
• Do you become very upset or experience heart pounding or difficulty in breathing when you are reminded of the event?
• Do you avoid thinking or talking about a bad experience related to the event? • Do you feel distant or isolated from people?
• Do you feel that your future is dark and there is no hope? • Do you get irritated/angry very easily now?
• Do you feel easily startled by small noises?
Activity 11
Role play:
Two participants will come voluntarily to act. One participant will ask at least three questions mentioned above to the other one. The other participant‘s task is to either answer the question verbally or can show the response by acting. Similarly, other participants will come forward to complete all the questions mentioned above. Finally, all the participants will discuss on it.
4.3 Information to be gathered for Community
Map:
Pre-Disaster Post-Disaster
1. Population and
demographics of (people, number of men, women, children, elderly)
• Number of families who have lost an earning member, number of injured and dead.
• No of widows, orphans and single women. • No of elderly injured, dead.
( i ) No of people with chronic diseases. ( ii ) Identifying people with non-adaptive
behaviors. For e.g., increased use of alcohol, increased violence in families. 2. Number of people
suffering from mental and physical disability.
No of people with physical and mental disabilities injured, losses suffered.
3. Transport and
communication (condition of roads, number of vehicles).
Loss of communication, condition of roads, means of transport to hospitals and nearest town.
4. Number of houses in the
community. Extent of damage to property. 5. Location of school
building, PHC, Talati’s office.
Extent of damage to school building, PHC, other structures.
Activity 12:
Group Work on Community Mapping (Refer: Annex 2.2)
5. Prevention in Mental Health: (Cohen, 2000)
‘Prevention’ refers to the means adopted to avoid disaster or crisis and be prepared before it occurs.
• Mental health prevention activities prevent a community from suffering acute emotional problems after a disaster. It helps a community to be better prepared to respond to a disaster or crisis event.
5.1 Primary Prevention:
• Primary prevention involves activities which will prepare the community to respond to a disaster.
• Its purpose is to reduce the risk factors and strengthen protective factors of the community and help it to meet its emotional needs.
• It requires the co-operation of different groups in the community and the organisations working within it.
Primary Prevention Activities of Mental Health
• Community mobilisation for bringing groups together.
• Participatory needs assessment for finding out strengths and weaknesses, protective and risk factors.
• Training to teach community members how to carry out disaster mental health/ psychosocial care activities.
• Mental Health promotion activities distribute information on DMH to community through media.
The responsibility for primary prevention lies with:
Primary Health centers, primary and secondary schools, Municipality at village level, Panchayat, support organisations within the community (balwadi, Aanganwadi), district administration (BDO’s office, Collector’s office) general public.
5.2 Secondary prevention:
Strategies used by the community and skills acquired to deal with disaster situations in a better way before, during and after the event.
Some secondary prevention activities are
• Techniques of stress management and self care • Building of social groups and social networks.
5.3 Tertiary prevention
Long term strategies to strengthen a community’s abilities to respond to crisis, with focus on providing psychosocial support and building resilience within the members of the community.
Some tertiary prevention activities are: • Facilitating meetings of community groups
• Conducting workshops on self care and free expression • Conducting stress management activities.
PRE/POST EVALUATION
Name:____________________________________________Date: ______________ Institute/organization to which he/she belongs:____________________________ Place:_______________________________________________________________
Mark with a cross (X) the correct answer:
1. Mental Health is:
a. To have a mental disease.
b. A concept not related with development.
c. A state of well-being that influences our capacity to respond. d. To avoid daily life problems.
2. What is Disaster Mental Health ?
a. Number of people going mad after a disaster.
b. Activities that reinforce pre-disaster adaptive behaviours. c. It is a punishment of God.
d. It is the damage caused by a natural or human-made phenomenon.
3. A Protective Factor can be:
a. A casual event.
b. A traumatic experience from the past. c. The opportunities of each individual. d. The strengths of the community.
4. A Risk Factor can be:
a. Insufficient support factors in the community. b. An accidental circumstance.
c. Training to face disasters. d. Stress.
5. What is Needs Assessment ?
a. Counting number of families.
b. Finding out needs of vulnerable people.
c. Identifying the protective and risk factors in a community. d. Finding out the number of dead in disasters.
Post Test
(Annex 2.1)
Module 2:
Psychosocial
Support in
Disasters
6. What do you mean by “BASIC” of stress reactions?
a. Basic needs
b. Basic knowledge about stress c. Physical factors of stress
d. Behavioural, affective, somatic, interpersonal and cognitive reactions.
7. Who are responsible for primary prevention in mental health?
a. PHC at the village level, municipality, the Panchayat and District administration.
b. Red Cross, st.Johns ambulance and state disaster committee. c. All the community people
EXAMPLE OF A VULNERABILITY MAP
Annex 2.2
Objective:
Promotion of Psychosocial support before, during and after a disaster.
Expected Outcome:
The community facilitator will be able to:
• Identify two ways in which psychosocial support promotion can be carried out in the community.
• Prepare and distribute materials for psychosocial support.
3
Promotion of
Psychosocial
Support
Discuss promotion of mental health and disaster mental health. Describe ways in which disaster mental health promotion can be carried out in the community. Prepare disaster mental health promotion material for the community.
PRE TEST (Annex no: 3.1)
1. Promotion of Psychosocial Support in Disasters.
1.1 What is promotion of Mental Health ?
Mental health promotion is both any action to enhance the mental well being of individuals, families, organizations and communities, and also a set of principles, which recognize that how people feel is a significant influence on health (Friedli, 2000).
1.2 What is promotion of psychosocial support?
Psychosocial support promotion is the strengthening of social bond before, during and after a disaster. It informs the community of the relevant factors of psychosocial well being. It educates them on how to deal with this behaviour pattern and communicate this information by various methods.The topics include:
• How individuals, families, organizations and communities feel before, during and after a disaster?
• The factors which influence how they feel.
• The impact of this on overall health and well-being of the community and individuals.
• How the community and individuals can deal with their feelings before, during and after a disaster.
(Refer to Handbook Q.No.1. Govind in the midst of a drought)
Promotion can be carried out in the community:
• When the community works together (community organization and participation).
• Distribution of information about what is psychosocial support and what to do in a disaster situation.
Activity 1.
Participants are given information on awareness regarding polio or HIV/AIDS. They are then asked to present any form of mental health promotion they think fit for any other problem /crisis situation.
This is followed by a Brainstorming.
1.3 Psychosocial Support promotion includes:
o Information: n psychosocial support promotion work it is important to give accurateinformation regarding the disaster event, relief, losses suffered and about all the survivors.
E.g. number of injured, where to receive relief material from, psychological and physical first aid etc.
o Education To promote psychosocial support, it is necessary to educate the people in the community that reactions to a disaster event are normal in abnormal situations. Education about disaster responses should be aimed at changing the attitudes of individuals and communities and bring about an understanding of the relevance of psychosocial support in disaster.
E.g. How do children respond to a disaster event ? What can we do to support our children during and after a disaster ?
o Communication To emphasize that communication channels have to be formed. The clearer the communication within the community, the better the adaptation. E.g. deciding on the kind of relief and services are needed by the community for
different kind of disaster.
(Refer to HANDBOOK Q.No. 2 Train Accident.)
2. How can we promote psychosocial support?
The topics related to psychosocial support affect all members in a community. Therefore, it is required that all members and groups in a community work together and discuss their problems amongst each other. Together, they can identify positive messages for psychosocial support and decide on how to distribute them amongst the community.
Promotion activities in the community should involve: • The organization.
• Social network.
2.1 What is an organization?
1. A place where members of a group or community come together. 2. With specific objectives and activities to perform.
3. Represent the best interests of its members/community.
Characteristics that the organization should have:
o Open communication. E.g. the people of the group should be able to talk about their ideas, comments and opinions with each other.
o Ideas of its members must be valued. Each and every member in a group is important and so is their contribution.
o Encourage discussion of new ideas. Psychosocial support activities have to be appropriate to the culture and circumstances, and there is not one formula that can be applied everywhere.
o The leaders don’t dominate and everybody should be able to share thoughts and opinions. The leader’s responsibility is to make sure that everybody has an equal share of rights and duties in the group.
o The decisions are taken with the participation of all the members.
(Refer to Handbook Module III Q.No. 3 Self Help Group.)
