impact seminar resilience development madrid, 8 & 9 february 2010 magda rooze ma/mba director...

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Magda Rooze MA/MBAdirector ImpactMadrid, 8 February 2010

GUIDELINES

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Overview

• Introduction

• Why guidelines?

• The Dutch multidisciplinary guidelines on early psychosocial interventions

• The ‘European value’ of the Dutch guidelines on early psychosocial interventions

• The Dutch multidisciplinary guidelines for uniformed aid workers

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Introduction /Main activities Impact

• Advice for professionals, policy makers, managers

• Gathering and sharing information– (Digital) Knowledge base– (International) congresses/conferences– Workshops and seminars– Publications– Newsletters

• Developing standards and guidelines

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Some Publications Impact

Together smarter / advice for interest groups of victims

Multidisciplinary guidelines on early intervention

World of difference / personal experiences of professionals and victims

Musical / resilience for children

Process model for the long term afterphase

‘Strong Shoulders’ / personal

experiences of uniformed aid

workers

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Why guidelines?

?

• Support instrument for practice

• No protocol, no ‘turn-key solution’

• Contribution to high-quality, evidence based psychosocial care

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Guideline development

• Specific methodology• Systematic literature research• Scientific research• Best-practices• Consensus• Authorisation (commitment)

evidence based

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

• What to do and what not to do during the first 6 weeks following disasters, terrorism or other shocking events/incidents.

– Supportive context

– Preventive early interventions

– Curative early interventions

– Organization

Dutch guidelines on early psychosocial interventions

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

A supportive context

•Practical support

•Providing information:

•Comforting explanation of normal reactions•Indicate when it is necessary to seek professional help•Advise to take up normal daily routine as soon as possible

•Show empathy

•Promoting the use of victim’s private supportive network

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Preventive interventions: Psychological triage

“Trained volunteers and relief workers play an

important role in recognising those affected with

psychological and/or serious clinical symptoms that

require diagnosis and/or treatment”

• Triage: identifying the need for psychosocial care

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Preventive interventions: Debriefing

“A strong advise against (one-off) psychological

debriefing with the aim to prevent PTSS and

other psychological problems.”

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Curative interventions: Treatment of symptoms

• Follow existing symptom-specific guidelines, protocols and standards

• As regular as possible; as culture-specific as possible.

• Acute Stress Disorder, serious symptoms of post traumatic stress and PTSS (>4 weeks): Trauma-focused cognitive behaviour therapy (CBT).

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Organization

• Within legal boundaries

• As regular as possible

• Collective interventions:

– Crisis/relief centre / assistance and support in acute

stage

– One-stop shop function

– Communication via the media

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

The ‘European value’ of the Dutch guidelines on early psychosocial interventions

• Questionnaire:– Agreement with guidelines recommendations (35 items)– Opinion– Practice– 5 point Likert scale

• Expert meeting:– 60 EU scientists, policy makers and (mental health)

experts in the field of post disaster psychosocial care– 25 countries in EU

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

The ‘European value’

• Overall: large overall agreement on the recommendations

• ‘Stage of development’ differs between countries

• Opinion does not equate practice (neither in The Netherlands or in the EU)

• Debriefing remains a controversial issue

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

The ‘European value’: debriefing NL vs EU

1

2

3

4

5

overall debriefing for victims debriefing for caregivers

Opinion NL

Opinion EU

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

The ‘European value’ of the Dutch guidelines

• Experts agree on the importance of implementation

• Already much ‘good practice’ in EU countries concerning provision of information

• However, the ‘stage of development’ is very different between countries, psychosocial interventions do not always have a high priority in policies

• In some countries CBT is not the ‘intervention of choice’

• More emphasis on children is perhaps needed

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Dutch multidisciplinary guidelines for uniformed aid workers

• Why this guideline?

• Methods

• Preliminary results

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Why this guideline?

• Uniformed aid workers are repeatedly exposed to potentially shocking events

• Organisations are legally, economically and morally obliged to ensure adequate (after)care for their employees

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

‘Facts & Findings’

• Prevalence of PTSD varies strongly among aid workers: 0% - 50%

• In general:− 10-20% PTSD− 0-27% Depression− 0-19% Anxiety − 3-25% Alcohol abuse− 5-20% General psychological complaints− 5-55% Unexplained physical complaints

• PTSD more prevalent in uniformed aid workers than in general population

• Need for multidisciplinary approach− Differences between professional aid organisations− Differences within organisations between regions

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Preliminary results

• Stepped care model (Gersons, 2005)

• Applicable to all professional aid services

• Leaves room for interpretation

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Preliminary results 2

• Focusgroups:

Despite differencesmany similarities

– Need for factfinding– Need for recognition– Timing of care– Blame

impact Seminar Resilience Development Madrid, 8 & 9 February 2010

Guidelines, not

tramlines!