Psychosocial care for adult and child survivors of the 2004 tsunami disaster in India

Improving mental ill-health with psycho-social group interventions in South Asia-A scoping review using a realist lens

This scoping review aimed to synthesise current evidence related to psycho-social groups as part of community-based mental health interventions in South Asia. We used a realist lens to pay attention to the contexts and mechanisms supporting positive outcomes. We included studies published from January 2007 to February 2022 that: were based in communities in South Asia, included a group component, reported on interventions with a clear psychosocial component, targeted adults and were implemented by lay community health workers. Two reviewers extracted data on intervention components, groups and facilitators, participant demographics and enabling contexts, mechanisms and outcomes. Expert reference panels including people with lived experience of psycho-social disability, mental health professionals and policy makers confirmed the validity and relevance of initial review findings. The review examined 15 interventions represented by 42 papers. Only four interventions were solely psycho-social and nearly all included psychoeducation and economic support. Only 8 of the 46 quantitative outcome measures used were developed in South Asia. In a context of social exclusion and limited autonomy for people with psychosocial disability, psychosocial support groups triggered five key mechanisms. Trusted relationships undergirded all mechanisms, and provided a sense of inclusion, social support and of being able to manage mental distress due to improved skills and knowledge. Over time group members felt a sense of belonging and collective strength meaning they were better able to advocate for their own well-being and address upstream social health determinants. This led to outcomes of improved mental health and social participation across the realms of intrapersonal, interpersonal and community. Psychosocial groups merit greater attention as an active ingredient in community interventions and also as an effective, relevant, acceptable and scalable platform that can promote and increase mental health in communities, through facilitation by lay community health workers.

A scoping review of community-based mental health intervention for children and adolescents in South Asia

Children and adolescents in South Asia are exposed to significant mental health risks. Yet, policy to prevent or treat youth mental health problems in this context is underdeveloped, and services are difficult to access. Community-based mental health treatment may offer a potential solution, by increasing resource capacity in deprived settings. However, little is known about the current community-based mental health provision for South Asian youth. A scoping review was conducted across six scientific databases and hand searching of reference lists to identify relevant studies. Study selection and data extraction were performed by three independent reviewers using predefined criteria, an adapted version of the template for intervention description and replication checklist and the Cochrane Risk of Bias Tool. The search identified 19 relevant studies published from January 2000 to March 2020. Studies most frequently addressed PTSD and autism, were conducted in India and Sri Lanka, used education-based intervention and were based in urban school settings. Community-based mental health provision for the South Asian youth is in its infancy, but holds promise for providing essential resources to treat or prevent mental health disorder. New insights on approaches are discussed, which are valuable for South Asian settings, primarily task-shifting and stigma reduction, with implications for policy, practice and research.

A proactive approach: Examples for integrating disaster risk reduction and mental health and psychosocial support programming

Natural disasters and humanitarian emergencies exert devastating impacts globally. Among these effects are disruptions in mental health and psychosocial well-being. Traditionally, mental health and psychosocial support (MHPSS) interventions have been implemented in response and recovery phases. Yet, the field of disaster management has demonstrated a shift towards disaster risk reduction (DRR). The degree to which the MHPSS field has followed this trend has been limited by several factors, including a lack of consensus-based guidance for MHPSS and DRR integration. However, examples from the field exist and demonstrate the feasibility of taking proactive approaches to supporting mental health and well-being and building better before emergencies occur. The following article outlines two case examples, one project in Sierra Leone and another in India, integrating MHPSS and DRR approaches and principles. Lessons learned from these cases and specific challenges in each context are highlighted and discussed.

Conceptualization of Major Stakeholders in Emergency Management of Childcare Facilities

This study aims to conceptualize the key stakeholders in emergency management of childcare facilities for applicable nations by referring to the Korean case. Qualitative content analysis is the main methodology used. Unique features are gathered from the Korean literature on childcare facilities and then summarized; however, universal principles from the English language literature on international childcare facilities are emphasized. The analysis of five major stakeholders in Korean childcare facilities, namely, governments, community personnel, parents, childcare providers, and children, shows that their current efforts are directed only at general safety management. Multi-hazard management or an integrated approach in terms of social work is thus provided as an alternative for not only Korea but also other nations.

Rehabilitation of vulnerable groups in emergencies and disasters: A systematic review

BACKGROUND

Natural and man-made disasters, especially those occurring in large scales not only result in human mortality, but also cause physical, psychological, and social disabilities. Providing effective rehabilitation services in time can decrease the frequency of such disabilities. The aim of the current study was to perform a systematic review related to rehabilitation of vulnerable groups in emergencies and disasters.

METHODS

The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The key words "recovery", "rehabilitation", "reconstruction", "transformation", "transition", "emergency", "disaster", "crisis", "hazard", "catastrophe", "tragedy", "mass casualty incident", "women", "female", "children", "pediatric", "disable", "handicap", "elder", "old" and "vulnerable" were used in combination with Boolean operators OR and AND. ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar were searched.

RESULTS

In this study a total of 11 928 articles were considered and 25 articles were selected for final review of rehabilitation of vulnerable groups based on the objective of this study. Twenty-five studies including six qualitative, sixteen cross-sectional and three randomized controlled trials were reviewed for rehabilitation of vulnerable groups in emergencies and disasters. Out of the selected papers, 23 were studied based on rehabilitation after natural disasters and the remaining were man-made disasters. Most types of rehabilitation were physical, social, psychological and economic.

CONCLUSION

The review of the papers showed different programs of physical, physiological, economic and social rehabilitations for vulnerable groups after emergencies and disasters. It may help health field managers better implement standard rehabilitation activities for vulnerable groups.

Development and Two-Year Follow-Up Evaluation of a Training Workshop for the Large Preventive Positive Psychology Happy Family Kitchen Project in Hong Kong

Evidence-based practice and capacity-building approaches are essential for large-scale health promotion interventions. However, there are few models in the literature to guide and evaluate training of social service workers in community settings. This paper presents the development and evaluation of the “train-the-trainer” workshop (TTT) for the first large scale, community-based, family intervention projects, entitled “Happy Family Kitchen Project” (HFK) under the FAMILY project, a Hong Kong Jockey Club Initiative for a Harmonious Society. The workshop aimed to enhance social workers’ competence and performance in applying positive psychology constructs in their family interventions under HFK to improve family well-being of the community they served. The two-day TTT was developed and implemented by a multidisciplinary team in partnership with community agencies to 50 social workers (64% women). It focused on the enhancement of knowledge, attitude, and practice of five specific positive psychology themes, which were the basis for the subsequent development of the 23 family interventions for 1419 participants. Acceptability and applicability were enhanced by completing a needs assessment prior to the training. The TTT was evaluated by trainees’ reactions to the training content and design, changes in learners (trainees) and benefits to the service organizations. Focus group interviews to evaluate the workshop at three months after the training, and questionnaire survey at pre-training, immediately after, six months, one year and two years after training were conducted. There were statistically significant increases with large to moderate effect size in perceived knowledge, self-efficacy and practice after training, which sustained to 2-year follow-up. Furthermore, there were statistically significant improvements in family communication and well-being of the participants in the HFK interventions they implemented after training. This paper offers a practical example of development, implementation and model-based evaluation of training programs, which may be helpful to others seeking to develop such programs in diverse communities.

Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries

BACKGROUND

Many people with mental, neurological and substance-use disorders (MNS) do not receive health care. Non-specialist health workers (NSHWs) and other professionals with health roles (OPHRs) are a key strategy for closing the treatment gap.

OBJECTIVES

To assess the effect of NSHWs and OPHRs delivering MNS interventions in primary and community health care in low- and middle-income countries.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 21 June 2012); MEDLINE, OvidSP; MEDLINE In Process & Other Non-Indexed Citations, OvidSP; EMBASE, OvidSP (searched 15 June 2012); CINAHL, EBSCOhost; PsycINFO, OvidSP (searched 18 and 19 June 2012); World Health Organization (WHO) Global Health Library (searched 29 June 2012); LILACS; the International Clinical Trials Registry Platform (WHO); OpenGrey; the metaRegister of Controlled Trials (searched 8 and 9 August 2012); Science Citation Index and Social Sciences Citation Index (ISI Web of Knowledge) (searched 2 October 2012) and reference lists, without language or date restrictions. We contacted authors for additional studies.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted-time-series studies of NSHWs/OPHR-delivered interventions in primary/community health care in low- and middle-income countries, and intended to improve outcomes in people with MNS disorders and in their carers. We defined an NSHW as any professional health worker (e.g. doctors, nurses and social workers) or lay health worker without specialised training in MNS disorders. OPHRs included people outside the health sector (only teachers in this review).

DATA COLLECTION AND ANALYSIS

Review authors double screened, double data-extracted and assessed risk of bias using standard formats. We grouped studies with similar interventions together. Where feasible, we combined data to obtain an overall estimate of effect.

MAIN RESULTS

The 38 included studies were from seven low- and 15 middle-income countries. Twenty-two studies used lay health workers, and most addressed depression or post-traumatic stress disorder (PTSD). The review shows that the use of NSHWs, compared with usual healthcare services: 1. may increase the number of adults who recover from depression or anxiety, or both, two to six months after treatment (prevalence of depression: risk ratio (RR) 0.30, 95% confidence interval (CI) 0.14 to 0.64; low-quality evidence); 2. may slightly reduce symptoms for mothers with perinatal depression (severity of depressive symptoms: standardised mean difference (SMD) -0.42, 95% CI -0.58 to -0.26; low-quality evidence); 3. may slightly reduce the symptoms of adults with PTSD (severity of PTSD symptoms: SMD -0.36, 95% CI -0.67 to -0.05; low-quality evidence); 4. probably slightly improves the symptoms of people with dementia (severity of behavioural symptoms: SMD -0.26, 95% CI -0.60 to 0.08; moderate-quality evidence); 5. probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia (carer burden: SMD -0.50, 95% CI -0.84 to -0.15; moderate-quality evidence); 6. may decrease the amount of alcohol consumed by people with alcohol-use disorders (drinks/drinking day in last 7 to 30 days: mean difference -1.68, 95% CI -2.79 to -0.57); low-quality evidence).It is uncertain whether lay health workers or teachers reduce PTSD symptoms among children. There were insufficient data to draw conclusions about the cost-effectiveness of using NSHWs or teachers, or about their impact on people with other MNS conditions. In addition, very few studies measured adverse effects of NSHW-led care - such effects could impact on the appropriateness and quality of care.

AUTHORS' CONCLUSIONS

Overall, NSHWs and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, PTSD and alcohol-use disorders, and patient- and carer-outcomes for dementia. However, this evidence is mostly low or very low quality, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific NSHW-led interventions are more effective.

Using the World Health Organization's 4S-Framework to Strengthen National Strategies, Policies and Services to Address Mental Health Problems in Adolescents in Resource-Constrained Settings

BACKGROUND

Most adolescents live in resource-constrained countries and their mental health has been less well recognised than other aspects of their health. The World Health Organization's 4-S Framework provides a structure for national initiatives to improve adolescent health through: gathering and using strategic information; developing evidence-informed policies; scaling up provision and use of health services; and strengthening linkages with other government sectors. The aim of this paper is to discuss how the findings of a recent systematic review of mental health problems in adolescents in resource-constrained settings might be applied using the 4-S Framework.

METHOD

Analysis of the implications of the findings of a systematic search of the English-language literature for national strategies, policies, services and cross-sectoral linkages to improve the mental health of adolescents in resource-constrained settings.

RESULTS

Data are available for only 33/112 [29%] resource-constrained countries, but in all where data are available, non-psychotic mental health problems in adolescents are identifiable, prevalent and associated with reduced quality of life, impaired participation and compromised development. In the absence of evidence about effective interventions in these settings expert opinion is that a broad public policy response which addresses direct strategies for prevention, early intervention and treatment; health service and health workforce requirements; social inclusion of marginalised groups of adolescents; and specific education is required. Specific endorsed strategies include public education, parent education, training for teachers and primary healthcare workers, psycho-educational curricula, identification through periodic screening of the most vulnerable and referral for care, and the availability of counsellors or other identified trained staff members in schools from whom adolescents can seek assistance for personal, peer and family relationship problems.

CONCLUSION

The predominant endorsed action is not that dedicated mental health services for adolescents are required, but that mental health care should be integrated using cross-sectoral strategies into the communities in which adolescents live, the institutions they attend and the organisations in which they participate.

Avian flu school: a training approach to prepare for H5N1 highly pathogenic avian influenza

Since the reemergence of highly pathogenic avian influenza (H5N1 HPAI) in 2003, a panzootic that is historically unprecedented in the number of infected flocks, geographic spread, and economic consequences for agriculture has developed. The epidemic has affected a wide range of birds and mammals, including humans. The ineffective management of outbreaks, mainly due to a lack of knowledge among those involved in detection, prevention, and response, points to the need for training on H5N1 HPAI. The main challenges are the multidisciplinary approach required, the lack of experts, the need to train at all levels, and the diversity of outbreak scenarios. Avian Flu School addresses these challenges through a three-level train-the-trainer program intended to minimize the health and economic impacts of H5N1 HPAI by improving a community's ability to prevent and respond, while protecting themselves and others. The course teaches need-to-know facts using highly flexible, interactive, and relevant materials.

Trained volunteer-delivered mental health support to those bereaved by Asian tsunami--an evaluation

INTRODUCTION

While mental health consequences following the Asian December 2004 tsunami have been studied, its impact on the survivors who lost close family members deserves attention. We investigated the usefulness of trained volunteer-delivered mental health support for the bereaved persons.

METHOD

Non-randomized control design involving all adults aged 18 years or above who lost at least one close family member during tsunami from two geographically different coastal areas in Chennai, India. From the intervention and control sites, 45 and 57 participants were recruited respectively for the study. One year after baseline assessment, all 102 participants in intervention and control sites were interviewed.

RESULTS

Participants receiving interventions on a consistent basis from trained volunteers were less likely to report depressive symptoms and general psychological distress compared with participants who did not receive the above intervention. Regression analysis for predicting the effect of intervention on the difference between the baseline and follow-up in BDI as well as GHQ scores, found a significant association between intervention and the improvement in BDI (adjusted beta (SE): -0.53 (2.44); p = 0.000) and GHQ (adjusted beta (SE): -0.52 (1.81); p = 0.001) scores. Suicidal attempts were also significantly less in the intervention group (FET p = 0.02).

CONCLUSION

In settings where mental health professionals are limited in number, trained lay volunteers can offer empathetic listening, support and referrals that can be potentially beneficial.

An evaluation of the Train the Trainer International Breast Health and Breast Cancer Education: lessons learned

BACKGROUND

Train the Trainer (TTT) Breast Health and Breast Cancer Education program was a workshop for nurses to improve knowledge about breast health and breast cancer.

METHODS

The TTT approach used several teaching-learning strategies. A total of 3 programs were held biannually since 2000; 32 nurses represented 20 international countries.

RESULTS

In 2000, participants represented developed countries. In 2002 and 2004, participants represented limited resource nations in Africa, Asia, and South America. Formative and summative evaluations using e-mail survey showed that over 1400 patients and families and over 900 nurses and doctors were reached.

CONCLUSIONS

Findings support viability of international breast health and/or breast cancer education programs.

Cultural perspectives of international breast health and breast cancer education

PURPOSE

To (a) describe teaching-learning strategies to foster cultural exchange among participants in the Train-The-Trainer (TTT) International Breast Health Program; (b) describe participants' perceptions of cultural influences on breast health and breast cancer; and (c) explore lessons learned about cultural influences on breast health TTT educational programs.

ORGANIZING CONSTRUCT

The TTT curriculum was grounded in the belief that nurses can effectively deliver breast health and breast cancer education, that educational programs must be culturally relevant and sensitive to the needs of the target population, and that an urgent need exists worldwide to reduce the burden of breast cancer.

METHODS

A total of 32 nurses from 20 countries participated in three TTT programs held before the biennial meetings of the International Society of Nurses in Cancer Care (ISNCC) since 2000, with follow-up by E-mail survey. Narrative descriptions of their perspectives and experiences are reported.

RESULTS

Teaching-learning strategies incorporated cultural values into a TTT program to engage participants in sharing their individual and collective experiences about women with breast cancer.

CONCLUSIONS

Developing countries are increasingly multicultural. Developed countries have large immigrant populations that generally maintain the cultural values and practices about breast cancer from the country of origin. These "lessons learned" are important in planning other educational programs.

The psychosocial consequences for children of mass violence, terrorism and disasters

Children and families are now in the front line of war, conflict and terrorism as a consequence of the paradigm shift in the nature of warfare and the growth of terror as a weapon. They are as vulnerable as are adults to the traumatizing effects of violence and mass violence. Furthermore, employing children as soldiers is not new, but it is continuing and young people are also perpetrators of other forms of violence. This paper summarizes a selection of the literature showing the direct and indirect psychosocial impacts on minors of their exposure to single incident (event) and recurrent or repetitive (process) violence. Additionally, children's psychosocial and physical development may be affected by their engagement with violence as victims or perpetrators. Several studies point to positive learning from certain experiences in particular communities while many others show the potential for lasting negative effects that may result in children being more vulnerable as adults. The spectrum of response is very wide. This paper focuses on resilience but also provides access to several frameworks for planning, delivering and assuring the quality of community and family-orientated and culture-sensitive responses to people's psychosocial needs in the aftermath of disasters of all kinds including those in which children and young people have been involved in mass violence.