Transcript Review of Community Recovery Initiatives SSPA Research

Review of Community
Recovery Initiatives
SSPA Research Workshop
2 June 2011
Request
• A briefing paper for the Wellbeing and
Resilience Intersectoral Task Group
and Healthy Christchurch
• Evidence about how to enhance
individual and community wellbeing
following a disaster, in particular
– How to support community resilience building
– How to provide psychosocial support for
individuals who need it.
Integrated and holistic
recovery
Methods
The international journal literature was
systematically searched using MEDLINE,
because this search engine allows
selection restricted to reviews of the
literature, and the Cochrane Database of
Systematic Reviews. An internet search
was also undertaken. Search terms used
included: “disaster, recovery, effective,
successful, community, initiatives,
prevent*, post traumatic stress, survey”.
Definitions
Recovery is the coordinated efforts and processes to effect the
immediate, medium, and long term holistic regeneration of a
community following a disaster
Resilience is the community’s ability to withstand the damage
caused by emergencies and disasters; it is a function of the
various factors that allow a community to respond to and
recover from emergencies
Psychosocial resilience is the capacity of individuals, families,
communities, systems and institutions to anticipate,
withstand, and/or judiciously engage with catastrophic
events and/or experiences, actively making meaning out of
adversity, with the goal of maintaining ‘normal’ function
without fundamentally losing their identity
Anticipated immediate reactions
(UK Department of Health Emergency Preparedness Division 2009)
Emotional
Cognitive
Social
Physical
Shock and
numbness
Fear and
anxiety
Helplessness
Hopelessness
Fear of
recurrence
Guilt
Anger
Anhedonia
Impaired
memory and
concentration
Confusion or
disorientation
Intrusive
thoughts
Dissociation or
denial
Reduced
confidence
Hypervigilance
Regression
Withdrawal
Irritability
Interpersonal
conflict
Avoidance
Insomnia
Hyperarousal
Headaches
Somatic
complaints
Reduced
appetite
Reduced
energy
Evidence-based
principles for recovery
• Promote a sense of safety
• Promote calming
• Promote a sense of self- and
collective efficacy
• Promote connectedness
• Promote hope
(Hobfoll et al 2009)
It is important to attend to the basic needs
of the population first, because the
stresses associated with restoring housing
and patterns of life can have as much
impact on psychological wellbeing as the
disaster itself.
(NATO 2008; Hutton 2001)
The ability of people to cope and adjust
to disaster events is often not so much a
function of disaster trauma as it is the
capacity of people to access tangible
assistance and support.
Timely financial and material resources
can not only mitigate the impacts of loss
and disruption, but allows people to
regain a sense of routine and normalcy in
their daily lives (Hutton 2001)
Recovery can be facilitated by helping
families and neighbourhoods to come
together as soon as possible to reestablish social networks and
communal life, provide opportunities for
people to identify and vocalize common
needs and priorities, and establish links
with government and other institutions
(Hutton 2001).
Because disaster may widen the gap
between the rich and the poor, it is vital
that agencies pay attention to issues of
social protection and economic
recovery.
Advocacy and engagement are vital
tools.
(Cosgrave 2008)
Providing psychological
support
• Most people recover from the stress
associated with a disaster without
medical or psychological assistance
• Some people experience a severe
response. Severe responses to stress
include post traumatic stress disorder
(PTSD)
• The occurrence of secondary stressors
(such as lengthy displacement from
homes) may increase the risk of people
developing severe responses
There is no evidence that psychological
debriefing is a useful treatment for the
prevention of PTSD (Rose et al 2009).
No psychological intervention can be
recommended for routine use following
traumatic events. Psychological
interventions may have an adverse effect
on some individuals (Roberts et al 2009).
Formal debriefing or screening of everyone
affected should not occur, but helpers should
be aware of the importance of identifying
individuals with significant difficulties.
Individual trauma-focussed cognitive
behavioural therapy is effective for the
treatment of acute traumatic stress
symptoms
(The European Network for Traumatic Stress
2008).
Successful initiatives
• Practical help given in an empathetic manner, emotional
support and initial reassurance of distressed individuals
• Information provisions (e.g. regarding tracing family
members, accessing temporary housing, food, social
benefits, health services, legal advice, and psychological
help)
• Material assistance (e.g. providing housing, food, financial
benefits, rebuilding infrastructure)
• Employment (e.g. retraining to increase employability and
independence)
• Organizing memorial events and building monuments in
conjunction with those directly affected
• Facilitating mutual support and special interest groups
• Providing psychosocial care interventions to the affected
populations