Mercy Malaysia Project Planv2

Project Plan for the Development of a Psychosocial Programme

Compiled by

Michael R. Montgomery

DRAFTv7th Dec 2007

CONTENTS

I. INTRODUCTION: 1

II. GENERAL PSYCHOSOCIAL INTERVENTION METHODOLOGY: 5

III. GENERAL FIELD MANUAL FOR PSYCHOSOCIAL INTERVENTIONS: 9

IV. INITIAL TRAINING PROGRAMME FOR STAFF: 10

V. RECRUITMENT OF VOLUNTEERS: 11

VI. SCREENING SYSTEM FOR VOLUNTEERS: 13

VII. FOCUSED TRAINING FOR VOLUNTEERS: 14

VIII. TRAINING OF TRAINERS (TOTs): 15

IX. FURTHER READING: 16

X. APPENDIX: 18

Compiled by Michael R. Montgomery for Mercy Malaysia 2007-8 2

I. INTRODUCTION

What is psychosocial?The term psychosocial is used by many agencies and individuals to mean many things. In its simplest form the concept points to the psychological and social aspects of an individual’s interaction with family, friends and society. It can be seen as more holistic approach to mental well-being and it incorporates a range of models of mental ill health in addition to the biological-medical model.

Psychosocial in the context of this document is used to refer to the interventions that may improve an individual or community’s mental well-being, endeavouring to reduce prolonged distress caused by the response to a disaster situation.


Psychosocial Well-Being

CULTURE and VALUES

SOCIAL ECOLOGY

HUMAN CAPACITY

Environmental Resources

PhysicalResources

EconomicResources

What is mental health?The concept of mental health carries with it a heavy burden due to stigma, misinformation and some superstition. Mental health is inseparable from political, social and economic issues and therefore is heavily dependent on context.

The more subjective elements of mental health including the actual causes can be made more objective when witnessing the psychological response to an emergency. It is clear that increased stress through the hardships faced by disaster, coupled with the distress caused by witnessing extreme events, and assimilating loss and bereavement, can contribute to issues with mental ill health in some people.

Some of these issues can include insomnia, anxiety, depression, loss of appetite, lethargy, lack of motivation, aggression, irritability, despair, intrusive thoughts, hopelessness, unpleasant dreams, somatic conditions and severe mental distress or mental ‘illness’.

Whilst many of these initial issues can be seen initially as a natural or appropriate response to disaster, prolonged occurrence can indicate that individuals and communities need additional support.

What is the usual presentation for someone who has lost their home, livelihood, friends, and loved ones? Whilst avoiding the medicalization of human misery Mercy Malaysia is committed to developing its psychosocial programme empowering communities to reduce distress and enhance recovery.

Background Mercy has previously provided a broad spectrum of psychosocial interventions, on a self-contained basis, in varying contexts. These have included (see Appendix):


Psychosocial First Aid (PFA)

Psychosocial EducationSelf-Help

GroupsPsychotherapy

Group Therapy

CounsellingGrief Work

TOTsArt TherapyStaff De-briefing

The review and recommendation from these interventions has highlighted the need to create a focused and sustainable psychosocial intervention programme.

It is understood that different cultures have their own ways of dealing with terrible traumas. Therefore it is important to avoid the medicalization of human misery and suffering by avoiding focusing, where possible, on trauma and pathology, and keeping community, culture, spirituality, and resilience front of mind. The objective of Mercy’s psychosocial programme is to use a strengths-focused, community-based empowerment model, targeting those who are most vulnerable with a clear focus on recovery.

The challenge will be to optimise resource to the maximum benefit to all beneficiaries.

The target outputs are: General Psychosocial Intervention Methodology, General Field Manual For Psychosocial Interventions, Initial Training Programme for Staff, Screening System for Volunteers, Focused Training Programme for Volunteers and Development Of Training Of Trainers.

The outputs are not static and have an interdependent relationship:


METHOD-OLOGY

FIELD MANUAL

STAFF TRAINING

RECRUIT-MENT

SCREENING

TRAINING

FIELD REVIEW

II. GENERAL PSYCHOSOCIAL INTERVENTION METHODOLOGY

A. PROJECT PLAN Purpose: To consolidate psychosocial initiatives into a structured

programme, ensuring a focused, ethical and community empowerment strategy, offering beneficiaries a degree of consistency and professionalism whilst reducing the potential for further trauma, abandonment, loss or oppression

Compiled by: Michael Montgomery Resources: Access to wide research baseInterdependencies: Meetings with Mercy staff to discuss logistics

Contact with previous volunteers to gain feedback on missions and insight into their experience

Sustainability: All training materials will be systematised and archived for future use

An approved Methodology will be converted into a field manual for consistence adherence to strategy

Risks: That by creating a methodology volunteers fails to embrace the nuances of each new situation including the depth of cultural difference and context including new strengths or potential threats

People get confused over breadth of psychosocial offering from Mercy Malaysia for example non-clinical issues such as housing and financial support

Timeline: Initial research, scoping and Project Plan: Dec 2007Further research and considerations: Jan 2008Begin to develop core principles: Feb 2008Further development and review: Mar 2008

B. INITIAL RESEARCH, REFLECTIONS AND CONSIDERATIONS :

1. An initial literature review has produced detailed and unified research and policy on psychosocial best practice in disaster environments

2. A decision will have to be made as to what depth Mercy Malaysia intends to provide a psychosocial programme or whether it wishes to develop a methodology and filter available resource through this to develop consistency

3. Psychosocial Intervention may be effective in a different sequence than other medical and humanitarian interventions for example interventions in early trauma counselling for those beneficiaries who have not recovered at the same rate may prevent the more serious development of PTSD or other mental


distress at a later date. Therefore intervention including assessments and referrals in the post-disaster stage could be seen as preventative work

4. By using support from local volunteers/staff to test and amend the concepts it will be possible to create a methodology with maximum local cultural relevance, beneficiary appropriateness, and international best practice for psychosocial interventions

Key Considerations in the Providing of a Psychosocial Intervention ProgrammeConsiderations Tasks

1. How best to make or obtain assessment information in order to provide services

Explore previous missions to establish on what basis the mission was set-up

Establish the type of assessment and whether, following a review, it was deemed effective

Consider the development of an assessment tool adaptable to each new situation

2. How to offer a psychosocial programme with limited resources

Emphasise the importance of community involvement and ownership

Select missions with maximum sustainability from community

Explore the unitary focus on TOTs3. How to ensure consistency in

intervention whilst avoiding exasperating a situation

Explore the appropriateness of brief-solution focused interventions and how it relates to empathy and psychologically holding

Ensure the field manual is adhered to and amended if deemed necessary

4. How to retain a knowledge and skill base that will ensure the programme is developing in accordance with best practice

Ensure that the overall methodology and developing knowledge base is systemically recorded to be eventually collated to form the basis of a field manual

5. To what level of response is required and deliverable

Emergency preparedness and prevention Minimum Response Comprehensive Response

6. At what stage of the disaster is the optimum intervention

Psychosocial Education: Prevention/Mitigation (pre-disaster)

Psychosocial Education: Preparedness (pre) Shadowed Psychosocial First Aid (PSF):

Response (post-disaster) Early Assessment and Referral:

Rehabilitation/Reconstruction (post)7. Ensuring the programme is

quantifiable Ensure quantitative data is recorded from

inception Follow-up with qualitative evaluation


Strategic and Ethical PrioritiesPriority DeliveryCultural Awareness, Sensitivities and Utilisation

UN/Malaysian Embassy Assessments

Gender Sensitivities Ensuring that where possible interventions are gender sensitive

Awareness of Increased Vulnerability Focus on unaccompanied children, women, elderly and those with an existing disability

Psychosocial Commitment Strengths and community focused Comprehensive Assessments Mission leader not necessarily a

psychiatrist Responsible prescribing

Existing Strengths Resources Coping mechanisms

Vulnerability/Resilience

Environment Resources Physical Resources Economic Resources Human Capacity Social Ecology Culture and Values

Interventions All available research should be reviewed in order to define the optimum timing for specific clinical interventions

Medication Mercy should have a commitment not to medicalised human behaviour. Where distress is serious enough to warrant a pharmacological intervention only generic drugs available in the affected country should be used unless prescribed for a specific short-term period such as to reduce acute over arousal that poses a risk to beneficiaries. The widespread use of benzodiazepines should be avoided due to the risk of dependence


Psychosocial AssessmentsOffline Assessment and Preparation: Online Assessment:

Awareness of cultural context and background including values

Establishing if there are traditional coping mechanisms for distress

Confirming if groups or one-to-one interventions are appropriate and exploring the most appropriate setting conducive to engagement

Amendment of assessment tool to incorporate the above

What agencies are involved and are there any assessments live

Ensure organic causes are eliminated such as head injury or toxic effects

Strengths assessment Cultural and community focused Building resilience and coping

mechanisms Early Referral System

Spectrum of Activities in Partnership with Local CommunityPotential Activities Deployment Phase Facilitator LevelPsychosocial First Aid (PDA) Emergency All Early Referral System All AllEmotional Support: Holding and Witnessing

All All

Psychosocial Education Emergency/Recovery AllAnxiety Management Emergency/Recovery AllArt Therapy Emergency/Recovery AllPlay Therapy Emergency/Recovery AllActivities for women and children All AllBasic Counselling Recovery/Development AllDepth Counselling/Psychotherapy Recovery/Development Counsellors and Clinical

ProfessionalsExtended Grief Work Recovery/Development Counsellors and Clinical

ProfessionalsGroup Work Recovery/Development Clinical ProfessionalsCognitive Behaviour Therapy (CBT)

Recovery/Development Trained

EMDR Recovery/Development TrainedIdentified enduring mental health issues

All Clinical professionals

Medication Recovery/Development Psychiatrists *Clinical professionals are professionals with clinical experience and training including: Clinical Psychologists, Psychiatrists, Psychiatric Social Workers, Psychiatric Nurses, Occupational Therapists, Psychotherapists and PsychiatristsAll= Psychosocial Assistants (PSAs), Counsellors and Clinical Professionals


III. GENERAL FIELD MANUAL FOR PSYCHOSOCIAL INTERVENTIONS

A. PROJECT PLAN Purpose: To provide a hardcopy outlining the psychosocial programmeCompiled by: Michael Montgomery Resources: Access to wide research base including the potential purchase of

psychosocial interventions in disasters materialsInterdependencies: Budget for design and printing

Corporate sponsorshipSustainability: A online version should be considered for immediate update,

accessibility and reproductionRisks: People may rely too heavily on the manual and not be flexible

enough to shifting situation and demands The manual does not get periodically reviewed and updated

therefore becomes a liability to best practiceTimeline: Initial research, scoping and Project Plan: Dec 2007

Further research and considerations: Jan 2008Start to compile in line with methodology: Feb 2008Continue to compile with methodology to date: Mar 2008


1. The scope of the field manual will need further definition including proposed length, content and final medium

2. Initial sections could be commenced including facts sheets on core issues for example ethics and Post Traumatic Stress Disorder (PTSD)


IV. INITIAL TRAINING PROGRAMME FOR STAFF

A. PROJECT PLAN Purpose: To raise awareness within the existing team of mental health

issues and psychosocial interventions. The proposed training will be modular in order to offer a chance to review and amend the inputs to optimise learning experience.

Facilitated by: Michael Montgomery and Potential Specialist VolunteersResources: Use of training facility

Refreshments Interdependencies: Process for inviting staff

Staff timeSustainability: The programme will be created in PowerPoint with accompanying

notes in order to provide future trainers with all the necessary material to complete the training

Risks: Turnover/accessibility of staff may mean non-attendance therefore making new modules less relevant or more challenging

Timeline: Initial research, scoping and Project Plan: Dec 2007Further research and considerations: Jan 2008Initial awareness training day: Feb 2008Review training and explore the need for more days: Mar 2008


1. There is often a gap in most emergencies between psychosocial supports and general health care. The way in which health care is provided often affects the psychosocial well-being of people living through a disaster

2. Raising awareness of psychosocial issues can create a strong foundation from which to build the programme

3. This programme will be broad in nature and core objective will be to raise awareness of psychosocial issues including: What is psychosocial? Mental Health and Mental Ill Health Psychosocial First Aid? Protecting oneself and Boundaries Grief Work and Trauma Assessment Basic Counselling


V. RECRUITMENT OF VOLUNTEERS

A. PROJECT PLAN Purpose: To recruit an new bank of psychosocial assistants and specialists

who will be trained in the new psychosocial programmeCompiled by: Michael Montgomery Resources: Adapting of existing screening models and best practiceInterdependencies: Support from recruitment personnel to develop a recruitment

policy for psychosocial assistants and specialists Sustainability: The recruitment department will observe the process of

recruitment from the initial intake in addition to institutions and partners being educated in what the requirements are

Risks: Alienating some specialists due to the need for some retraining

Alienating volunteers due to the nature of the recruitment policy

Attract a large number of unusable individuals wishing to get psychosocial experience

Timeline: Initial research, scoping and Project Plan: Dec 2007Review previous volunteers and explore new recruitment streams: Jan 2008Interview new candidates: Feb 2008Prepare volunteers for training: Mar 2008


1. The Screening System will be used to ensure the optimum selection of volunteers

2. Although there is a core need for specialists, it is vital that the commitment to psychosocial interventions is of paramount concern. It is therefore advisable that only a professional who can fulfil the strategy of the programme will lead the team. This may result in psychiatrist not being the lead professional.

3. If cultural hierarchy permits it would be productive to have the team multi-disciplinary in content and focus


Multidisciplinary Working:


Psychosocial Assistants

ClinicalCounsellors

Clinical Professionals

VI. SCREENING SYSTEM FOR PSYCHOSOCIAL VOLUNTEERS

A. PROJECT PLAN Purpose: To ensure that consideration is given to the current suitability of

volunteers to psychosocial interventions in disaster environment. This is to safeguard against the stress and trauma for the volunteer and to ensure solid and equipped volunteers for the beneficiaries

Compiled by: Michael Montgomery Resources: Adapting of existing screening models and best practiceInterdependencies: Support from recruitment personnel to incorporate the screening

into their existing recruitment processSustainability: The system will be compiled and implemented and reviewed after

implementation and post filed debrief. Once reviewed it will be become a ongoing component of the recruitment process

Risks: If integrated with general recruitment it may take more time in the interview process

The nature of the screening may put some people off volunteering

Timeline: Initial research, scoping and Project Plan: Dec 2007System integration: Jan 2008Implementation: Feb 2008Review and amend: Mar 2008


1. It is imperative that the individuals involved in psychosocial intervention are in good health and of sound mind. To support this objective it is recommended that a screening programme be put in place to explore: Personality suitability including emotional maturity Experience of personal loss Pre-health scale including existing life stress Levels of self-awareness including competencies and weaknesses

2. Quality of interpersonal communication


VII. FOCUSED TRAINING FOR VOLUNTEERS

A. PROJECT PLAN Purpose: To train Specialists, Counsellors and Psychosocial Assistants

(PSAs) on core competencies of psychosocial programme and Specialists in strategy for intervention to reduce role ambiguity, reduce role conflicts and explore role position and limitations.

Facilitated by: Michael Montgomery and Selected SpecialistsResources: Use of Training Facility

Refreshments Interdependencies: Staff TimeSustainability: The programme will be created in PowerPoint with

accompanying notes in order to provide future trainers with all the necessary material to complete the training.

Risks: May give false sense of abilityTimeline: Initial research, scoping and Project Plan: Dec 2007

Further research of previous training including feedback from participants: Jan 2008Development of training modules: Feb 2008Delivery of first wave of training for volunteers: Mar 2008


1. This programme will could offer two main training programmes, ideally these programmes would be integrated to support team building:

a. Psychosocial training for specialistsb. Training for counsellors and psychosocial assistants

2. Suggested areas covered: What is psychosocial Mental Health Impact of interventions Psychosocial first aid Communication skills: Listening to others and oneself, Empathy, NVC Counselling Skills Protecting oneself Boundaries

3. The desired level of intervention will effect the final training package


VIII. TRAINING OF TRAINERS (TOT)

A. PROJECT PLAN Purpose: To deliver psychosocial education and training to trainers in

beneficiary community to ensure sustainable and culturally appropriate responses to distress

Facilitated by: Michael Montgomery and Selected SpecialistsResources: Use of Training Facility

Refreshments Interdependencies: Staff TimeSustainability: The programme will be created in PowerPoint with

accompanying notes in order to provide future trainers with all the necessary material to complete the training.

Risks: May give false sense of abilityTimeline: Initial research, scoping and Project Plan: Dec 2007

Further research of previous training including feedback from participants: Jan 2008Development of training modules: Feb 2008Delivery of first wave of training for volunteers: Mar 2008


1. This programme may become priority number one if the appraisal of resources and potential interventions demonstrates that psychosocial education and training are more expedient and productive to sustain long term change in presenting beneficiaries psychosocial problems

2. Potential trainers:a. Psychosocial training for specialistsb. Training for focused non-specialist trainersc. General psychosocial education

3. Suggested areas covered: What is psychosocial Mental Health Psychosocial first aid Trauma Basics of counselling


IX. FURTHER READING

Action Without Borders (2007) ‘Recruitment and Screening Psychosocial’ [Online] Available at: http://www.psychosocial.org/psychosocial/resources/pre_mgr_recruitment.html

Anderson, M. (1999) Do No Harm: How Aid Can Support Peace – or War. USA: Lynne Rienner

Asian Disaster Reduction and Response Network (ADRRN) [Online]http://www.adrrn.net/index.asp

CSTS (2007) ‘Psychological First Aid - Psychological First Aid: How You Can Support Well-Being in Disaster Victims’ [Online] Available at: http://www.centerforthestudyoftraumaticstress.org/downloads/CSTS_Psych1stAid.pdf

Gauthamadas, U. (2006) ‘A Model for Crisis Intervention in Large Scale Disasters using Lay Community Counsellors’ [Online] Available at: http://www.adeptasia.org/publications.aspx

Gauthamadas, U. (2006) ‘Disaster Psychosocial Response - Handbook for Community Counsellor Trainers’ [Online] Available at: http://www.adeptasia.org/publications.aspx

Halpern, J. and Tramontin, M. (2006) Disaster Mental Health: Theory and Practice.

Humanitarian Accountability Partnership - International [Online] http://www.hapinternational.org/

Humanitarian Reform (2007) ‘What is the Cluster Approach’ [Online] Available at: http://www.humanitarianreform.org/humanitarianreform/Default.aspx?tabid=70

Inter-Agency Standing Committee (IASC) (2007) ‘Guidelines on Mental Health and Psychosocial Support in Emergency Settings’ [Online] Available at: http://www.icva.ch/doc00002363.pdf

International Council of Voluntary Agencies (ICVA) [Online] Available at: http://www.icva.ch/

International Journal of Psychosocial Rehabilitation [Online] http://www.psychosocial.com/

Medecins Sans Frontiers [Online] Available at: http://www.doctorswithoutborders.org/home.cfm


Myers, D., Wee, D. (2005) Disasters in Mental Health Services: A Primer for Practitioners. Basingstoke: Routledge

National Centre for PTSD [Online] Available at: http://www.ncptsd.va.gov/ncmain/index.jsp

The National Child Traumatic Stress Centre (2007) Psychological First Aid - Field Operations Guide (2nd ed) [Online] Available at: http://www.nctsn.org/

National Institute of Mental Health (2002) ‘Mental Health and Mass Violence: Evidence-Based Early Psychological Interventions for Victims/Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices’ [Online] Available at: http://www.nimh.nih.gov

Norris, F., Galea, G., Friedman, M. Watson, P. (eds) (2006) Methods for Disaster Mental Health Research. NYC: The Guilford Press

Patel, V. (2003) Where There Is No Psychiatrist: A Mental Health Care Manual. London: Royal College of Psychiatrists

Peters, L. and Slade, T. (2004) ‘A Comparison of ICD10 and DSM-IV Criteria for Post-traumatic Stress’. Journal of Traumatic Stress, April, 1999, Vol:12(2), P:335-345

Resiliency in Action (2007) ‘Resiliency Quiz’ [Online] http://www.resiliency.com/htm/resiliencyquiz.htm

Ritchie, E., Watson, P., Friedman, M. (eds) (2005) Interventions Following Mass Violence and Disasters: Strategies for Mental Health Practice. NYC: The Guilford Press

SAMHSA (2007) ‘Psychological First Aid for First Responders: Tips for Emergency and Disaster Response Workers ‘ [Online] Available at: http://mentalhealth.samhsa.gov/Disasterrelief/pubs/manemotion.asp

Psychosocial Network [Online] Available at: http://psychosocialnetwork.net/library

The Sphere Project (2007) ‘The Sphere Project – Humanitarian Charter and Minimum Standards in Disaster Response – Mental and Social Aspects of Health’ [Online] Available at: http://www.sphereproject.org/

WHO (2003) Mental Health in Emergencies: Mental and Social Aspects of Populations Exposed to Extreme Stressors. Geneva: World Health Organisation


WHO/UNHCR (1996) Mental Health of Refugees. Geneva: World Health Organisation http://whqlibdoc.who.int

WHO (2007) ‘WHO Model List of Essential Medicines 15th list, March 2007’ [Online] Available at: http://www.who.int/medicines/publications/EML15.pdf


X. APPENDIX – Summary of Recent Mercy Psychosocial Activities

2005

Kota Kuala Muda, Kedah, Malaysia

Phase One: Emergency Response

Psychosocial Health Support: Psychosocial counselling to communities through mobile clinics continuing even after

people had moved to temporary accommodation Aim to restore normalcy; cleaning school compound and paint playground so that

classes could resume

Aceh, Indonesia

Phase one: Emergency Response

Psychosocial Health Support: Trauma counselling and mental health support Tent visits by psychiatrists, clinical psychologists, art therapy and activities for women

and children Psychological first aid and debriefing

(Prof. Dr. Hatta Shahron)

Phase Two: Recovery and Rehabilitation

Mental Health Support Programmes at various IDP (Internally Displaced People) camps: Counselling Community Intervention Drawing and Story Telling Activities

Distress identified: PTSD symptoms with anxiety and depression Unresolved grief Major Depression

(Yasmin Majid)


Feb 2005

Ampara, Sri Lanka


Psychosocial Health Support: Education programmes using interactive posters as education and psychosocial

materials shared with the community; posters later adapted and used by UNICEF for similar programmes

For children: art therapy and counselling. 500 out of the 2,000 survivors who were counselled by Mercy volunteers were children

Trauma counselling sessions for adult communities for bereavement and to strengthen coping mechanisms


Mental Health and Support Psychosocial Programmes: Support the Kalmuni Hospitals Mental Health Unit; individual, family, group and

community counselling

Mental Health Support Training Programme: Psychosocial Education of ‘para-counsellors’ in recognising and counselling minor

psychological symptoms for long term benefits to local community Local volunteers were trained to provide counselling and facilitate the activities for

children and women in IDP camps 2 Phases; Basic and Advanced Family Support Workers training including:

o Counselling sessions (individually and group)o Crisis interventiono Grief managemento Team buildingo Self-help training & Child/adolescent training

Nov 2005

Pakistan

Phase One: Emergency Response


Psychosocial Health Support: Issues included reactive depression and grief including anxiety, sleep disorders and

psychosomatic complaints

Dec 2005

Pakistan


Psychosocial Health Support: Assisting Rawalpindi Military Hospital of Psychiatry’s Mental Health Relief Unit;

individual psychotherapy sessions at their field clinics and during our mobile clinics Psychological-education training to medical officers, female health workers, religious

leaders, teachers and District Hospital Quarters staff: assisting them in recognising and facilitating referrals of mental health cases to the mental health units in Bagh

Phase 3: Development and Capacity Building

No action

Jul & August 2006

KL

Training for trainers Stress Art Therapy

Jul – Sep 2006

Yogjakarta, Indonesia


Psychosocial First Aid (PSF): Immediate cases of post traumatic trauma



Mental Health Support: 9 schools in Bantul Psychosocial training for students and teachers: psychological response to disaster,

intervention during acute emergency and reconsolidation phases and psychosocial care for children

Training of trainers: undergraduates, school counsellors etc.

Mission: 11, 12, 13 & 14: Mission: 16 & 17: Mission 18: 21 Aug – 3 Sep 2006 (Full Report)

(Dr Affizal, Agung, Hermawan, Faley, Abdi, Yafit, Rahmah, Fitah, Runy: Rohani)

Nov 2006

Basic and advanced Psychosocial and Mental Health Intervention: 6 day training for 38 participants: staff members and volunteers, plus 5 from Islamic

Health Society (IHS) in Lebanon Aim to develop on-hand pool of skilled volunteers for emergency response unit


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