We are not crazy!We are not crazy!
What we feel is not abnormal– What we feel is not abnormal– the situation is crazy and the situation is crazy and
abnormal!”abnormal!”
-- a rural child in Bosnia Herzgovina(Source: “The Tiger is our Guest,” CARE, 2005)
SESSION 1: Objectives of the Workshop
• To share and map experience on PSS in Emergency and Humanitarian Response in the Horn of Africa
• To increase understanding of psychosocial support in emergencies, including objectives, strategies and activities
• To identify next steps for further development of PSS in Emergency Response in the Horn of Africa
Programme Presentations can include: Coordination issuesPsychosocial AssessmentsObjectives of programmes and indicatorsMain activitiesWhat sectors are programmes implemented in (child protection, health, education etc.)Psychosocial evaluationStrengths and challenges of your programme
Session 2: Country Presentations and Mapping
Session 3: Psychosocial Wellbeing and Support
• Psychosocial wellbeing
• Psychosocial support
What do these terms mean?
What is the difference between them?
Why do we use the term psychosocial?
Psychosocial wellbeing
Psychosocial wellbeing is the sense of wellbeing that exists at the individual, family and community level.
Psychosocial support is a composite term used to describe any type of local or outside support that aims to protect or promote psychosocial well-being
Psychosocial programming is often used to describe psychosocial support that is externally supported
There are a number of models for wellbeing.
3 Domains of Psychosocial Well-Being (Psychosocial Working Group model)
Individual Capacity
Societal Culture
and Values
Family and Community
Social-ecological model of psychosocial wellbeing
Wellbeing exists at the following levels:• Individual• Family• Community/Society
And at each level can include the following:• Social wellbeing• Emotional wellbeing• Skills and knowledge
Example of psychosocial wellbeing
Individual level:• Ability to form and maintain positive relationships
with caregivers, peers and positive role models • Sense of security, trust, self-confidence and
hope for the future • Life skills/empowermentFamily: • Ability to protect, care and support children and
other family members • Ability to address and reduce the stresses of
poverty, violence
Psychosocial wellbeing
Community/society level
• Community mobilization to address psychosocial concerns, including awareness of how to address them
• Community cohesion, social support and tolerance
What do we mean by “psychosocial?”
The dynamic relationship between psychological and social effects of experiences, each continually influencing the other
PSYCHOLOGY• Mind• Thoughts• Emotions• Feelings• Behaviors
SOCIAL WORLD• Environment• Culture• Traditions• Relationships • Roles and tasks
Psychosocial Programming: Strategies and Activities
Exercise:
1. In small groups you will draw a pyramid divided into four (4) sections.
Imagine the pyramid represents a population affected by an emergency
2. You will receive four (4) strips of paper indicating levels of psychosocial support
3. Place the paper on the appropriate levels of the pyramid
Specialisedservices
Focused,non-specialised supports
Basic services and security
Community and family supports
(continued)
• What kind of psychosocial activities should be conducted at each level
• Who should benefit from the activities at each level
• Who should conduct activities at each level?
Level 1: Addressing Basic Services and Security Advocate for the protection of children from violence, abuse
and exploitation
Advocate for re-establishing education
Promote family unity and family-based care for separated children
Promoting family self-reliance
Advocate for delivery of humanitarian assistance in a manner that promotes well-being
Facilitate community involvement in decision-making and assistance
Disseminate essential information to affected populations
Level 2: Community and Family Supports
Support play, art and sporting activities
Provide structured groups activities for expression and the development of life skills and coping mechanisms
Support children and youth friendly spaces/environments
Promote meaningful opportunities to participate in rebuilding society
Level 2 (cont’d)
Strengthening the family:– Provide culturally appropriate guidance on how
parents and family members can help children– Support parents and families to cope with their own
difficulties– Support and facilitate the establishment of parent
groups/committees– Carry out regular family visits for caregivers in need
of extra support– Support family access to basic services
Level 2 (cont’d)
Strengthening community supports:– Helping caregivers and educators to better cope– Help key people to support children– Teacher training on psychosocial care and support– Training for health personnel– Psychosocial support for adult caregivers– Strengthen child-to-child or youth support– Resumption of cultural activities– Strengthening social networks
Level 3: Focused Supports
For children who are:
– struggling to cope within their existing care network
– Not progressing in terms of their development
– Unable to function as well as their peers
– In need of activities that address their psychosocial needs more directly
Level 3 (cont’d)
• Focused psychosocial support activities require trained and experienced staff
• Activities may include:– Case management– Psychological first aid– Support groups– Structured play activities– Psychosocial hotlines
Level 4: Specialized Services
• Traditional specialized healing (e.g. cleansing and purification rituals)
• Counseling (individual, family or group)
• Psychotherapy
• Drug or alcohol treatment
• Custodial mental health care
• Training of local mental health workers
Psychosocial Programming
Form 4 small groups, each of which will discuss one of the levels.
Each groups should consider:
• What programming do the members of the group currently do at this level?
• How could they improve the programming at this level?
Session 4: Impacts of an Emergency on Psychosocial Well-Being
• The individual capacity of a person• Physical
• Emotional
• Behavioral
• Cognitive
• Status
• Family and community functioning• Displacement
• Extra burdens on families
• Community supports eroded or destroyed
• Societal Culture and Values• Sense of violation
• Beliefs and values undermined, changed
• Loss of identity
Potential Positive Outcomes of an Emergency on Psychosocial Well-Being
Greater awareness of rights
Children and communities can become more active in supporting themselves
Greater access to information
Change in gender roles
Opportunities for social change
Characteristics of an Emergency that Affect Psychosocial Well-Being
• Scope of secondary effects of the emergency
• Duration of the emergency
• Degree of impact on daily living situation
Children’s reactions will vary according to:
• Their experience in the emergency
• Individual characteristics
• Past experiences
• The level of support they receive
• The situation of their family, community
• Their beliefs and values
Role of Culture on a Child’s Reaction to an Emergency
Impact on parenting• Who looks after children
• How they are cared for
Impact on status, traditional roles and ethnicity• Discrimination
• Changes in traditional gender roles
• Language barriers with movement
Faith and value systems• Expressions of grief and loss
• Acceptance of support for emotional difficulties
• Healing processes
Role of Gender on a Child’s Reaction to an Emergency
Men, women, boys and girls are affected differently because of their different roles and the power relations in society
What might be the different experiences of girls and boys in emergency situations?
Common Psychosocial Reactions in Children
• Physical reactions
• Changes in thinking e.g. beliefs and values
• Changes in emotions
• Changes in behavior e.g. more passive or aggressive
• Changes in social relations
• Nearly all children will show some changes in emotions. behavior, thoughts and social relations in the short term
• These reactions are normal, and with access to basic services, support and security the majority of children will regain normal functioning.
• Mild or moderate mental health problems will increase slightly after an emergency
• A very small percentage of persons will have severe mental illness
Session 5: Strategies to Strengthen and Protect Children’s Psychosocial
Wellbeing
Children’s outcomes are determined by the balance of risk factors and protective factors.
Risk and protective factors exist at individual, family and community level.
RESILIENCE . . .
A person’s ability to overcome difficulties and adapt to change
Determined by the following protective factors:• Individual characteristics of a child (e.g.)
• Ability to problem solve and express oneself
• Hope for the future
• Self-respect
• Ability to access resources
• Family and Community factors• Secure attachment with parents or caregivers
• Caregivers who model positive coping skills
• Established routine and structure in daily life
• Safety and security
Strategies to strengthen psychosocial wellbeing
How can we reduce risk factors and strengthen protective factors?
• Strengthen children’s life skills• Enhance routine and structure in children’s lives• Provide opportunities for children to participate in and
contribute to their communities and a more positive future
• Strengthen ability of child’s support network to protect and care for the child
• Provide support for caregivers (families, teachers etc)• Strengthen basic services and security (through
advocacy, coordination etc)
Session 11: Psychosocial Planning
1. Coordinate2. Undertake an assessment3. Plan activities based on assessment4. Address basic services and security issues
that impact on psychosocial well-being5. Mobilize family and community support6. Develop structured psychosocial programs
(if needed)7. Refer to appropriate mental health services8. Monitor and evaluate
Basic Principles of Psychosocial Care and Support in Emergency Settings
•Human Rights and Equity
•Participation
•Do No Harm
•Build on available resources and capacities
•Integrated Support Systems
•Multi-Layered Supports(Source: IASC Guidelines)
We should not focus on trauma
• Traumatic experiences are only one aspect of difficult situations e.g. social and economic stressors often identified as more difficult
• Most importantly: a stress reaction only becomes a disorder if it impairs daily functioning or involves intense suffering
• “PTSD” is a clinical syndrome that can only be diagnosed and treated by a qualified psychologist or psychiatrist. There are specific symptoms that must have a certain duration
• Should avoid single disorder programming
Overuse of this word can be:
• Inaccurate (only an extremely small percentage of the population will have PTSD)
• Stigmatizing
• Counterproductive to healing
• Encouraging a passive victim identity
• Deflecting attention away from the broader social context
Session 13: Indicators, Monitoring and Evaluation
Why monitor and evaluate?
“The primary purpose of an evaluation is to identify the strengths and weaknesses of an intervention (sic) to improve that intervention and ultimately others like it”
For psychosocial projects:
• To build evidence base for what works
• To minimise harm or risk of doing harm
Principles of Monitoring and Evaluation
• Culturally grounded and participatory (working with communities to determine local understanding of wellbeing and distress, ensuring tools are culturally appropriate/validated)
• Informed consent and feedback• Confidentiality• Sensitivity to consequences (sensitive
interviewing, appropriate follow-up etc.)
Indicators
• Output (process) - what was done e.g. how many trainings
• Outcome (immediate results) - immediate effects of activities on beneficaries e.g decreased levels of fear
• Impact (lasting results) – mid or long-term change in status or behaviour as a result of our project e.g. greater levels of participation in school
Indicators
Indicators should be: SpecificMeasurableAppropriateRealisticTime-bound
e.g. Reduce children’s feelings of isolation through strengthening attachments with friends
SMART: reduce feelings of isolation by increasing the number and quality of peer friendships and attachment to supportive adults
Indicators
Qualitative
• Children’s understanding and ability to make sense of their experience
Quantitative
• Percentage of children involved in activities in their community
• Responses on checklist
Monitoring and Evaluation
Key methodological considerations:• Causality versus changes• Ethical comparison groups• Participatory methods• Who do you collect information from? Sampling
including sample size and random sampling• Ethical comparison groups• Triangulation • Use of combined quantitative/qualitative• What tools will you use?
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