Strengthening the Mental Health and Psychosocial Support Response for Disaster-Affected areas of Dominica

Innovation summary

The Commonwealth of Dominica is located in one of the most disaster-prone regions in the world and has a history of hurricanes and tropical storms that have caused a lot of damage to infrastructure and livelihoods¹. On the 18^th of September 2017, a category five storm, named ‘Hurricane Maria’ left a devastating impact on the local populations, with many people missing, injured and an estimated 90% of buildings damaged¹.

Multiple humanitarian based agencies were independently carrying out MHPSS activities, but these efforts lacked documentation and coordination. International Medical Corps developed this programme to address the needs of the population by strengthening the existing resources for a more effective and locally-driven humanitarian response.

The MHPSS programme had four key objectives:

Assess MHPSS needs and resources
Establish a coordinated mechanism for MHPSS activities
Improve local capacity to respond to the MHPSS needs of the affected population
Increase awareness and use of international best-practice guidelines on MHPSS in emergencies

Impact summary

By March 2018, IMC achieved the following activities as part of their programme:

Completed an MHPSS assessment report with key recommendations for action to be undertaken by key local and international actors in order to improve the response
Improved MHPSS coordination among local and international actors by creating a MHPSS and Gender-Based Violence Working Group
Conducted Psychological First Aid training sessions for community leaders as well as training-of-trainers (ToT).
Implemented a workshop on promoting MHPSS best practice guidelines for government agencies, staff from NGOs and the education sector and faith-based organizations
Designed and disseminated helpline posters to facilitate and increase sources of support for community members in emergency settings

“Understanding and respecting a person’s capabilities; understanding what they can do, rather than just going in to give help.”
- A community leader when speaking about PFA training

Innovation details

1. Assessing MHPSS needs and resources

IMC implemented a rapid MHPSS assessment in October 2017 to understand the needs of communities affected by Hurricane Maria, identify existing services and resources, and generate recommendations to inform program design. The assessment tools used were adapted from the UNHCR/WHO MHPSS Assessment Toolkit² which included a review of available MHPSS services (the ‘4Ws’ mapping exercise), community needs and current sources of distress. The assessment concluded with seven recommendations for actions to be jointly undertaken by MHPSS actors to improve the response (available in resources).

2. Coordination of MHPSS response activities

Informed by key recommendations for action from the assessment stage, in October 2017 IMC established a Working Group to improve the coordination of MHPSS and Gender-Based Violence (GBV) activities. The group consisted of 29 organizations, including government bodies, local and international NGOs, faith-based organizations, private MHPSS providers and UN agencies. These coordination meetings were held bi-weekly, were chaired by IMC and discussions were based on the following objectives (full list available in resources):

Ensure an effective, coordinated and focused inter-agency response to the MHPSS/GBV needs of the Dominican population affected by Hurricane Maria

Identify gaps in MHPSS/GBV response and facilitate coordinated action

Promote the leadership of the government, and encourage the representation of diverse MHPSS and GBV stakeholders

3. Improving local capacity to respond to MHPSS needs

IMC implemented participatory one-day workshops with over 200 community leaders (e.g. village council members, health workers, teachers, fire officers, local NGO staff etc) in order to improve the local capacity of providers to address the MHPSS needs of disaster-affected populations. These community leaders were invited to participate in the workshop via text messages. The workshops were based on Psychological First Aid (PFA), an approach that seeks to provide practical and emotional support to people who have recently experienced a distressing event and were administered by a program manager and clinical psychologist. In order to plan for a sustainable mechanism for continued activities, a PFA Training-of-Trainers was implemented and focused on: 1) Revision of training slides and activities, 2) Facilitation Tips, 3 Introduction to MHPSS Best Practice Guidelines, and 4) Orientation to training ‘Starter Packs’.

4. Increasing awareness and use of MHPSS best practice guidelines and psychosocial support services

IMC’s assessment stage highlighted a rich network of local agencies involved in MHPSS activities; however, their potential impact was limited by the lack of a formal coordination mechanisms and limited awareness of relevant international best practice guidelines. IMC conducted two full-day orientation workshops to address these needs as well as distribute copies of the IASC Best Practice Guidelines for MHPSS in Emergency Settings³ to relevant agencies. Promotional activities to increase the awareness of available psychosocial support services for community members were also implemented. Posters of helpline numbers was designed and displayed in health facilities, village councils, churches and other public areas with potential of high visibility.

Key drivers

Effective coverage

Broad geographical coverage was achieved, particularly for the PFA training, with at least one community leader trained from almost all towns and villages nationwide.

Program activities were designed based on a thorough assessment and mapping of local needs and resources.

Positive feedback

Trainees reported that the interactive training methods used were engaging and helpful in consolidating learning and demonstrating real-life applicability with 100% of trainees surveyed stating that they would recommend the workshops to others.

Successful stakeholder engagement

Multi-sectoral approach and engagement of both governmental and non-governmental actors increased the reach and impact of the program. A strong relationship was established with the Ministry of Health, with a possibility of a standby agreement.

Sustainability

Focus on local capacity-building and distribution of evidence-informed training materials and best practice guidance increased the likelihood of longer-term impact and sustainability.

Challenges

Limited existing data

Prior to the assessment, there had been no MHPSS technical coordination or mapping activity conducted.

Lack of MHPSS coordination

Multiple implementing agencies were independently carrying out MHPSS activities but were not centrally coordinated and there was no documentation of what activities were being conducted and which geographical locations were receiving support.

Continuation

In order to continue the Working Group coordination meetings, the chairing role for the meetings was phased over to the Ministry of Social Services Family and Gender Affairs at the close of the program.

In the interest of sustainability, a PFA Training-of-Trainers workshop was also held where trainees were given a revision of training slides and activities and provided with PFA training starter packs (included the print materials needed to run a training for 10 people and a USB Flash Drive containing electronic versions to be printed as needed).

Lessons Learned:

It is recommended that the MHPSS Working Group continues to meet regularly to coordinate relevant activities and to promote best practices. Working Group members are prepared to continue to collaborate under the leadership of the Ministry of Social Services, in partnership with local and international NGOs.

The most consistent piece of feedback from trainees was the desire for further training, both in terms of follow-up sessions and reaching a wider audience. Given the interest and demand that has been generated by this program, and a growing recognition among community members of the potential impact of emergencies on psychosocial wellbeing, it is recommended that MHPSS capacity-building activities continue. This will support the current response and improve preparedness as the 2018 hurricane season approaches. For example, those that have been trained as PFA trainers are equipped to continue delivering PFA training throughout the island. This may be coordinated through the MHPSS Working Group.

A disproportionate number of females were represented in trainings, and the need to have more males trained in MHPSS was a recurring theme in participant feedback. Future programs should make a special effort to recruit males, for example, by engaging organizations that have a higher proportion of male staff where MHPSS skills are highly relevant, such as the police and fire services.

Evaluation methods

IMC evaluated all three of the workshops implemented through their MHPSS program:

PFA workshops were evaluated through a battery of pre- and post- self-report questionnaires. These questionnaires measured self-reported competency, improvements in knowledge and an evaluation of the workshop quality, content and teaching methods.
The PFA training of trainers workshop was evaluated with similar methods i.e. a four-item scale where participants were asked to rate their level of agreement with statements such as ‘The workshop gave me practical skills and knowledge’.
Participants attending the workshops on best practices for MHPSS in emergencies also completed an evaluation form at the completion of the sessions on a six-item scale.

Cost of implementation

An analysis of costs was not implemented as part of this project.

Impact details

Objective 1: Assess MHPSS needs and resources

Completed MHPSS assessment and disseminated report to stakeholders

Developed an MHPSS/GBV 4Ws Matrix, which has been shared with the relevant actors and is being used to direct referrals.

Developed list of recommendations (see Assessment report in Reports section)

Objective 2: Establish a coordinated mechanism for MHPSS activities

Established the MHPSS Working Group to improve coordination among MHPSS actors. Biweekly working group meetings are chaired by IMC and attended by: Ministry of Health, Ministry of Social Services, Ministry of Education, Unicef, UNFPA, OCHA, IOM, IsraAID, Dominica Psychological Society, the Dominica NGO Coalition, the National Council of Women, and local NGOs working with vulnerable groups. The chairing role was phased over to the Ministry of Social Services, Family and Gender Affairs in March 2018.

Collaborated with IOM to include MHPSS questions in the Displacement Tracking Matrix and the associated tools used to collect data on those living in shelters.

Promoted adherence to Best Practice Guidelines through the working group, and planned five trainings on the IASC Guidelines for February 2018.

Objective 3: Improve local capacity to respond to the MHPSS needs of the affected population

Trained 212 community leaders (36 males, 176 females) nationwide in Psychological First Aid, 50% of attendees were government representatives (18% local and 32% central), while 39% represented NGOs or Community-Based Organizations (CBOs).
Improvements in perceived competencies and knowledge:
Perceived competencies were measured on a nine-item scale, which addressed self-reported competency on skills such as: the ability to support people who have experienced disasters, the ability to recognize people in distress, and the ability to link people affected by disasters to services and information. Improvements in knowledge were assessed using seven ‘true or false’ questions (e.g. “[When helping someone in distress after a disaster, you should] ask the person to recount the details of their traumatic experience.”).
- Mean Perceived Competency Score increased from 74% to 91% between pre- and post-training surveys. The largest gains in perceived competency were for the following items:
  - Knowledge of what to say and do in order to be helpful to someone in distress (23% improvement)
  - Knowledge of things to avoid doing and saying (that could unintentionally cause harm) (22% improvement)
  - Ability to prepare for and approach a crisis situation safely (18% improvement)
  - Ability to take care of yourself when assisting people affected by crisis (18% improvement)
- Mean helping skills scores increased from 65% to 86% between pre- and post-training surveys.
Trained and equipped 26 psychosocial workers to continue running Psychological First Aid workshops after program close
Built the capacity of 16 local MHPSS providers through workshops on art-based techniques for psychosocial support

Trained 44 key actors from NGOs, government bodies, education institutions and faith-based organizations in two key areas 1) International Humanitarian Architecture and 2) International best practices for MHPSS in emergencies

Training evaluations demonstrated that participants valued the practical, interactive teaching methods, which they felt helped them to retain the information and would make it easier to apply the skills in real life.

Objective 4: Increase awareness and use of international best-practice guidelines on MHPSS in emergencies

Distributed 500 WHO PFA Field Worker Guides to relevant actors

Distributed 30 WHO PFA Facilitator Manuals to relevant actors

Distributed 150 copies of the IASC Best Practice Guidelines to relevant organizations

Developed and distributed 400 national helpline posters to raise awareness of available MHPSS services

References

ACAPS (2017) Dominica: Country Profile. [Link]
WHO/UNHCR (2012) Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Humanitarian Settings.
Inter-Agency Standing Committee (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.