Psychoeducation, Psychological first aid,

Psychosocial support, “terminology"

ENPS Forum 2013, Istanbul

B. Juen

University of Innsbruck

Austrian Red Cross

To give an overview of the definitions for the most used

terms in the field of psychosocial support as well as the

state of the art in the three areas

Psychosocial support

Psychological First Aid

Psychoeducation

Aim of the presentation

Psychosocial support (PSS) is an umbrella approach,

following the intervention principles named by Hobfoll

et al. (2007) with the aim of promoting resilience of

individuals, groups and communities in crisis.

Psychosocial support includes a broad variety of

interventions promoting the resources of individuals,

families or groups as well as the community as a whole.

Psychosocial Support

The aim is to establish a resilience promoting context by the use of various programmes and activities

e.g. Community outreach encouraging and supporting community initiatives, such as home-based support, school-based interventions, vocational and skills based trainings, establishing community centres

establishing support groups

e.g. Psychological First Aid being available and assessing needs

contacting relatives

giving information

organizing practical matters

E.g. Psychoeducation giving information and enabling dialogue about stress reactions and good ways of coping

Providing psychosocial support to

affected people can be done in many

different ways

Source: IFRC Reference Centre for Psychosocial Support

Beslan: After the Beslan school siege in 2004, the International Federation and the

Russian Red Cross established a community centre, a visiting nurses programme and

summer camps for the affected children.

Sierra Leone: In Sierra Leone, girls who had been abducted and sexually exploited by

armed groups often experienced stigmatization and harassment when they returned.

Community dialogue helped local people understand the girls and Girls’ Well-Being

Committees imposed fines for mistreatment of the girls. Both initiatives reduced abuse

and supported their reintegration into the communities.

India: A mourning house was established on the edge of a mass grave in one of the

areas affected by the Indian Ocean tsunami, where people could enter to have a

moment of silence. The house later developed into a community centre.

Some examples of psychosocial

support activities

In psychosocial support you should focus upon the five key elements

Safety

Connectedness

Self and Collective Efficacy

Calm

Hope

Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, P. R., De Jong, J. T. V. M., Layne, C. M., Maguen, S., Neria, Y., Norwood, A. E., Pynoos, R. S., Reissman, D., Ruzek, J. I., Shalev, A. Y., Solomon, Z., Steinberg, A. M., Ursano, R. J. (2007): Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry 70 (4), 283–315.

State of the art

Psychosocial support is the umbrella approach on the

level of intervention design

Psychological first aid and psychoeducation are

intervention strategies within the approach

Umbrella approach versus

intervention strategies

Psychological First Aid (PFA) is an element of psychosocial

support that can be effectively applied by trained lay-people

including volunteers but is also used by professionals.

Psychological First Aid

New material on

Psychological First Aid

http://www.who.int/mental_health/publications/guide_field_workers/ Psychological first aid: Guide for field workers Authors: WHO, War Trauma Foundation and World Vision International Publication details Number of pages: 64Publication date: 2011Languages: Arabic, Chinese, English, French, Japanese, Korean, Romanian, Spanish.ISBN: 978 92 4 154820 5

PFA is an intervention form that contains the following elements

Providing practical care and support, which does not intrude;

Assessing needs and concerns;

Helping people to address basic needs (for example, food and

water, information);

Listening to people, but not pressuring them to talk;

Comforting people and helping them to feel calm;

Helping people connect to information, services and social

supports;

Protecting people from further harm.

(World Health Organization, War Trauma Foundation & World Vision International (2011). Psychological first aid: Guide for field workers. WHO: Geneva)

Psychological First Aid (PFA)

Principle Actions

LOOK

.

Observe for safety.

Observe for people with obvious urgent basic needs.

Observe for people with serious distress reactions

LISTEN

Make contact with people who may need support

Ask about people’s needs and concerns

Listen to people, and help them to feel calm

LINK

Help people address basic needs and access services

Help people cope with problems

Give information

Connect people with loved ones and social support

Psychological First Aid involves the

following key activities

Do not use classical active listening which is too confrontational (do not focus on emotions, stay on cognitive level)

Focus on needs, practical and emotional support (information, being active, connecting and use of resources)

Help people protect themselves and regulate their stress (calm) go with the symptom, help people to distance themselves, encourage self protection

Freeman, C, Flitcroft, A, & Weeple, P. (2003) Psychological First Aid: A Replacement for Psychological Debriefing. Short-Term post Trauma Responses for Individuals and Groups. The Cullen-Rivers Centre for Traumatic Stress, Royal Edinburgh Hospital.

Ehlers, A , Clark, D M (2003) Early psychological interventions for adult survivors of trauma, Journal of biological Pschiatry, 53, pp 817-826

State of the art

Education refers to the provision of knowledge and skills to a given target group which involves teaching that can be done in a broad variety of ways.

Psychoeducation means the provision of information to the affected persons and groups as well as the initiation of a dialogue about the nature of stress, posttraumatic and other symptoms, and what to do about them.

The provision of psychoeducation can occur before possible exposure to stressful situations or after exposure. The intention is to ameliorate or mitigate the effects of exposure to extreme situations.

Psychoeducation

Examples from the IFRC Reference Centre Training

materials

Psychoeducation is an important aspect

in psychosocial support programmes

and training

Information education and communication (IEC) materials

Four brochures

• Stress and coping • Children’s stress • Working in

stressful situations • Psychological First

Aid

Three information sheets

• Supporting volunteers (for NS)

• Info sheet for ERU staff,

• All children deserve to be safe

State of the art

Be aware of possible medicalisation and too much confrontaion

Do not use formal classical debriefing Do not be too confrontational (no pressure to talk about the details of the event and the emotional side of the experience)

Do not do formal screening but do risk assessment

Do not predict symptoms, but make people understand their reactions

Do not be too educational (some researchers prefer the term psychoinformation)

Focus on positive coping and resilience

Rose S, Bisson J, Churchill R, Wessely S. (2007) Psychological debriefing for preventing post traumatic stress disorder (PTSD) (Review) In: The Cochrane Library, 2007, Issue 1

• An umbrella approach directed at individuals, families, groups and communities in crisis. Based upon the five principles named by Hobfoll (safety, connectedness, self-collective efficacy, calm, hope). Aim: enhancing resilience.

Psychosocial Support (PSS)

• An intervention strategy under the PSS umbrella aimed at individual(s) and groups in acute crisis, a humane and supportive response to a suffering human being that can be provided by lay people. Aim: reducing acute stress and promoting active coping and use of resources

Psychological First Aid (PFA)

• An educational intervention (two way process) under the umbrella of PSS aiming at enhancing an understanding of stress reactions and promoting positive coping (in the Hobfoll scheme it is mainly the principles of calm and efficacy that are active here)

Psychoeducation

Summary/Framework

Persons doing psychosocial support have to be able to

1. Develop programmes and/or activities for people in crisis that fit the five principles of Hobfoll and enhance the resilience of individuals, families and communities in crisis. These programmes/activities have to be adapted to the needs of the given individuals and groups, context, situation, culture and community, community outreach is an important aspect

2. Use Psychological First Aid as a Strategy in actually communicating and interacting with people in acute crisis with the focus on safety, connecting, activation of resources and self protection

3. Use Psychoeducation when being in contact with higly distressed individuals and groups in order to help them understand their reactions and make use of positive coping strategies with the focus on stabilisation and resilience

How do the three terms connect in

practice?

Therefore PSS trainings have to involve all three elements

Psychosocial support (Knowledge about grief, stress, resilience, the five elements of Hobfoll and how to translate them into action and develop PSS community outreach programmes)

Psychological first aid (Knowledge about how to approach persons in acute crisis, how to assess their needs, how to support them practically and help them to stay active, how to protect them from too much confrontation and how to connect them with further social support)

Psychoeducation (Knowledge about stress, its course and ways of coping as well as being able to use a variety of didactic ways to inform the affected individuals and communities about stress and positive coping without being too confrontational and too eduactional)

Resumee

Thank you for your attention