Strategic Recommendations for Psychosocial Support

By Jona M. Meyer

Diese Leitlinien für psychosoziale Unterstützung wurden speziell im Hinblick auf die komplexen Herausforderungen von Krisenmanagern entwickelt. Die zugrunde liegende Forschung entstand im Rahmen eines, von der Europäischen Kommission geförderten, internationalen Projektes. Neben einem neuen Katastrophenphasen-Modell, gehört auch eine innovative, evidenzbasierte online Applikation zu den Hauptergebnissen dieser Forschung. Die Arbeit könnte daher nicht nur für Krisenmanager, sondern auch andere Führungskräfte, entsprechende Entscheidungsträger, Wissenschaftler oder Leitlinien-Entwickler von Interesse sein.
This set of recommendations for psychosocial support was developed particularly for disaster managers with strategic responsibilities. The development process was part of an international research project, which had received funding from the European Commission.
Besides producing a novel disaster phase model, the process yielded an innovative, evidence-based online application of strategic recommendations for psychosocial support. The findings and challenges may be of interest not only for disaster managers, but middle and higher management in general, policy makers, researchers and guideline developers.

• Language: English
• Publisher: Books on Demand
• Release date: May 22, 2017
• ISBN: 9783744842341

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Abstract

A set of recommendations for psychosocial support was developed particularly for disaster managers with strategic responsibilities. This development process was part of the research project PsyCris (PSYchosocial support in CRISis Management), which had received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement number 312395. The overall process was based on the methodology laid out in the Handbook for Supporting the Development of Health System Guidance (Bosch-Capblanch, 2011) and drew on evidence from 46 existing guidelines related to the topic, which were appraised using the AGREE II online tool. Additional supplementary data included colloquial evidence from European crisis managers and other stakeholder, which had been collected via qualitative methods such as incident templates, questions sheets and interviews, or observations of large-scale exercises. The data collection process was designed as a QUAL-qual mixed method paradigm and data was synthesized using a combination of the best fit framework synthesis, which includes the creation of an a priori framework against which data was coded, and the critical interpretative synthesis to enable flexible and dynamic analyses of different types of data.

The process generated recommendations that could broadly be categorised as: "psychosocial support provided by the disaster managers, psychosocial support provided for disaster managers and further considerations". The process also generated eight novel descriptions of disaster phases. Upon the external review and acceptance by the Research Executive Agency of the European Commission, the guidelines were further developed into an online application. Experts on guideline development, and psychosocial support in disaster settings from the European Federation for Psychologists’ Associations’ (EFPA) Standing Committee on Disaster, Crisis and Trauma Psychology evaluated the online version by means of a Nominal Group Technique. The evaluated guidelines were then prepared to fit the requirements of the envisioned PsyCris training and networking platform.

Besides contributing to general research in guideline development, the process yielded an innovative, evidence-based online application of strategic recommendations for psychosocial support, alongside a novel disaster phase model. Findings and challenges are discussed in the context of this process and expected to be of interest not only for disaster managers, but policy makers, researchers and guideline developers.

Acknowledgements

I would like to thank my research supervisor PD Dr. Markos Maragkos, without whom this research would not have been possible. I would also like to thank Prof. Dr. Corinna Reck for assessing this dissertation as well as Prof. Dr. Johannes Moser for his support. I also thank Prof. Dr. Thomas Ehring, who encouraged me through his constructive feedback, and would have even trusted me to take over the project coordination when times got tough. Tremendous gratitude belongs to Prof. Dr. Vera Kempe, who initially had offered me a PhD position, and has remained a source of encouragement, and a friend ever since.

Special thanks also belongs to Prof. Dr. Lars Weisæth, Marc Stein, and Guy Weis for their advice during critical stages of the development process as well as Prof. Dr. Avi Kirschenbaum, Simon van Dam, and Dr. Pandelis Perakakis. I am also enormously grateful for the support of the following members of the European Federation for Psychologists‘ Assosiations (EFPA) Standing Committee for Crisis and Disaster Psychology, who thoroughly evaluated these recommendations in light of the current state-of-the-art: Lucia Formenti, Nathalie Garcia Manitz, Eva Håkanson, Eva Münker-Kramer, Dr. Julia Richter, Magda Rooze, Dr. Salli Saari, Márcio Simão Pereira, Dr. Dominique Szepielak, and Prof. Dr. William Yule as well as all other project partners, with whom I had the privilege of sharing the PsyCris experience. Another very special thanks belongs to the exceptional Attila Sirman.

Last, but certainly not least, I am of course also very grateful to my wife for her tireless support.

Table of Contents

Abstract

Acknowledgements

List of Figures

List of Tables

List of abbreviations

Introduction

1.1. Research context and theoretical background

1.1.1. The PsyCris project

1.1.2. Disaster description

1.1.3. Disaster phases

1.1.4. Psychosocial support description

1.1.5. Disaster management description

1.1.6. Guideline development for strategic psychosocial support

1.2. Theoretical implications

1.2.1. Terminology in the context of strategic recommendations for psychosocial support

1.2.2. Psychosocial support in the context of strategic recommendations

1.2.3. Guideline development in the context of strategic psychosocial support

1.2.4. Disaster phases in the context of strategic recommendations for psychosocial support

Methodology

2.1. Guidance Development Group

2.2. Framing the problem and scoping the guidance

2.3. Searching for evidence

2.3.1. The best fit framework synthesis

2.3.2.The critical interpretative synthesis

2.4. Building the a priori framework

2.4.1. Affected population description

2.4.2. Preliminary disaster phase model

2.5. Initial a priori framework

Process

3.1. Retrieving existing guidelines

3.1.1. Appraising existing guidelines

3.1.1.1. Appraisal results of existing guidelines

3.2. Collection of supplementary primary data

3.2.1. Qualitative Rapid Appraisal, Rigorous Approach

3.2.2. Equity considerations for supplementary primary research

3.2.3. Case specific data collection

3.2.4. Data collection across project partner countries

3.2.4.1. Question sheets

3.2.4.2. Country profiles

3.2.5. Disaster exercise observations

3.2.5.1. Observation of the Puchberg exercise in Austria

3.2.5.2. Observation of the EU Modex exercise in Luxembourg

3.2.5.3. Observation of the Luxair exercise in Luxembourg

3.2.6. Summary of collection of supplementary data

Analyses and results

4.1. Disaster phase model for psychosocial support

4.2. Evidence on psychosocial support

4.3. Updating the a priori framework

4.3.1. Disaster Resilience Manager description

4.4. Boundaries of psychosocial support

4.5. Write up of draft recommendations

4.5.1. Draft recommendations for strategic psychosocial support

Discussion of results

5.1. Discussion of the eight disaster phases

5.2. Discussion of the psychosocial support results and the Disaster Resilience Manager

5.3. Discussion of writing up the draft recommendations

Reviewing and finalising the strategic recommendation for psychosocial support

6.1. Internal review of draft

6.2. External review of draft

6.3. Finalising recommendations

Development of online version

7.1. Overview of the online application’s features

Evaluation with external stakeholders

8.1. The Nominal Group Technique

8.2. Results of the Nominal Group Technique

8.3. Discussion of the Nominal Group Technique evaluation

Preparation for project use

9.1. Structure to present recommendations via PPP Platform

Monitoring and updating guidelines

10.1. Framework to monitor recommendations

10.2. Framework to update recommendations

Limitations and future research

11.1. Limitations of the rationale

11.2. Limitations of the implementation or adherence

11.3. Limitations of the use of existing guidelines

11.4. Limitations of the use of supplementary data

11.5. Limitations of evidence on interventions and implementation issues

11.6. Limitations of the syntheses of findings

11.7. Limitations of the review procedure

11.8. More general limitations

Final remarks

References

Appendices

List of Figures

Figure 1.PsyCris work package structure (DoW, 2013).

Figure 2.Schematic outline of methodology used to develop this set of recommendations

Figure 3.Schematic overview of potentially affected population

Figure 4.Depiction of the initial a priori framework used for the best fit framework synthesis

Figure 5.Flowchart of searches for and retrieval of existing guideline material

Figure 6.Overall assessment scores for each of the 46 documents appraised with AGREE II

Figure 7.Appraisal scores for scope and purpose, stakeholder involvement, and clarity of presentation for each of the 46 documents appraised with AGREE II

Figure 8.Appraisal score for rigour and development for each of the 46 documents appraised with AGREE II

Figure 9.Appraisal score for applicability for each of the 46 documents appraised with AGREE II

Figure 10.Appraisal score for editorial independence for each of the 46 documents appraised with AGREE II

Figure 11.Data extraction concerning civil protection and disaster management according to phase descriptions based on findings from appraised guidelines (visualisation adapted from Cuny, 1986)

Figure 12.Depiction of the updated a priori framework

Figure 13.Screenshot of online application home page of strategic recommendations

Figure 14.Screenshot of online application of strategic recommendations with expanded phase.

Figure 15.Median ranks in reference to total number of received ranks per note of final top ten notes

Figure 16.Median ranks in reference to total number of received ranks per note of order 11-30.

Figure 17.Mock-up of landing page for PPP Platform integration of guidelines

Figure 18.Mock-up of entry level for PPP Platform integration of guidelines

Figure 19.Mock-up of advanced level for PPP Platform integration of guidelines

Figure 20.Mock-up of expert level for PPP Platform integration of guidelines

List of Tables

Table 1PsyCris project consortium

Table 2Input, process and output components of strategic recommendations for psychosocial support

Table 3Framing the problem in reference to the scope of guidance and methodological implications

Table 4Preliminary disaster phase model for psychosocial support showing the development from four to eight phases

Table 5Generic search strategy for recommendations on psychosocial support in a disaster context including disaster management aspects

Table 6Key terms for full text eligibility assessment

Table 7Domains and items of the AGREE II instrument with comments for possible adaptations

Table 8Overview of sources used for the four incident templates according to disaster scenario and project partner

Table 9Overview of sources used for the six question sheets according to project partner and country

Table 10Descriptive properties of eight disaster phases for strategic psychosocial support

Table 11Themes used to extract evidence for psychosocial support from a strategic perspective

Table 12Types of evidence and their inclusion in the recommendation write up

Table 13Set of draft recommendations for strategic psychosocial support

Table 14Summary of internal review in relation to inclusion process

Table 15Summary of external review in relation to inclusion process

Table 16Revised stages of the salutogenic notion in light of the strategic recommendations for psychosocial support

Table 17List of themes (families) based on groups of items

Table 18Types of items and corresponding symbols

Table 19Overview of top ten notes including descriptions, and summaries of further process

Table 20Example of attributes of applicability and transferability for strategic psychosocial support recommendations by measures of uptake (blank version)

List of abbreviations

1. Introduction

In light of the tragic consequences of any type of disaster, it is not surprising to find an abundance of recommendations, guidelines or instructions on how to prevent, prepare or respond to such events. Among this body of literature, one will find various specifications depending on such parameters as: purpose, target audience or author/commissioning body of the respective document. One group among these documents may be categorised as psychosocial support or mental health guidance documents that focus on such aspects within the context of disaster preparation, response or recovery. While each of these pieces of literature is valuable in its own right by contributing to the safety and well-being of those involved, it appears only few such documents exist that specifically target disaster managers, and more precisely that provide guidance concerning psychosocial support in disaster management (see Te Brake & Dückers, 2013).

In 2011 however, under the Seventh Framework Programme for research, technological development and demonstration (FP7), the European Union had issued the call SEC-2012.4.1-2 (European Commission, 2011), which had asked for proposals to address aspects of psychosocial support for those in charge, namely the crisis management. The PsyCris (PSYchosocial support in CRISis management) consortium’s proposal had been accepted in response to this call and - among other objectives - set out to contribute to this body of literature by developing a set of recommendations for psychosocial support regarding the responsibilities of disaster managers. This dissertation describes the scientific development of this particular set of recommendations.

1.1. Research context and theoretical background

In order to better understand how this process came to be and was operationalized, a few underlying concepts and definitions will be presented in the following paragraphs. A European perspective will be taken whenever possible and appropriate, due to the European Union’s foci inherent in most FP7 funding programmes. Since the primary rationale for the development of these guidelines is rooted in the abovementioned call (SEC-2012.4.1-2), these theoretical concepts will only be briefly discussed. While these, or certain inherent aspects certainly provide grounds for further discussion, such explorations have been undertaken elsewhere (e.g., Alexander, 2002; Boin & Bynander, 2015; Bosch-Capblanch, Liaqat, & Garner, 2011; Dombrowsky, 1995; Dückers, 2013; Jones, Greenberg, & Wessely, 2007; Shultz & Forbes, 2014; Weiss, Saraceno, Saxena, & van Ommeren, 2003) and would exceed the scope of this document. It is however recognised that the concepts and definitions presented here neither are conclusive, complete nor claim to be beyond debate. Instead, they may be regarded as a necessary framework of concepts or assumptions, and to a certain extent even a preceding rationale, from which further insights could be induced (cf., Hume, 1779).

1.1.1 The PsyCris project

PsyCris, which stands for Psychosocial support in crisis management, was the name of a research and development project that received funding under the European Union’s Seventh Framework Programme (FP7) under Grant Agreement Number 312395. The envisioned runtime of the project was 36 months (starting July 2013). The project consortium was made up of ten partners shown in Table 1 under the coordination of Ludwigs-Maximilians-Universität München. The partners represented five European member states and Israel, which is considered a fully associated partner country under FP7.

Table 1 PsyCris project consortium

The basis of the work proposed by any FP7 research project is documented in the so-called Description of Work (DoW). Aside from the underlying rationale and administrative matters, the DoW outlines the thematic and operational structure of the project in work packages (WP) as well as the objectives of each work package, which are further broken down into tasks. Figure 1 depicts the proposed nine work packages of PsyCris and their names and structure as shown in the DoW (DoW, 2013).

Figure 1. PsyCris work package structure (DoW, 2013).

The overall objectives of PsyCris aimed to improve psychosocial support in crisis management by developing various components (e.g., stress assessment, stress management, contingency planning, help the people help themselves) [that] will be integrated in an overall PsyCris Tool Kit Demonstrator, which will be based on a comprehensive knowledge system (Preparedness-Planning-Prevention [PPP] Platform) (DoW, 2013). As shown in Figure 1, this PPP Platform (i.e., WP7) may be perceived as the main exploitable output produced by the project, since it takes up elements (called tools) of the other work packages so as to arrive at a final product (Adler, Sauter, Meyer, Hagl, & Raich, 2015).

The work described in this dissertation fell under work package 2 (WP2). However, it only constituted part of the general WP2 objectives, which had been proposed as follows: "[…] an optimisation of psychosocial and medical intervention for disaster victims, intervention forces and the larger community during and after crisis situations. Most effective intervention tools and their availability in EU countries are identified for immediate (e.g., Acute Stress Disorder, [ASD]) and long-term (e.g., Post-Traumatic Stress Disorder, [PTSD]) consequences of crises. Applied analysis methods include e.g., qualitative interviews with experts, meta-analyses of empirical intervention studies¹, and analyses of evaluation reports of psycho-medical care following mass emergencies. The impacts of cultural differences and gender on treatment efficacy are also regarded. (DoW, 2013). The development of guidelines has been further outlined in task 2.3 (T2.3) by emphasizing the identification of efficient interventions for immediate/ post-immediate and long-term treatment and in task 2.4 (T2.4) by placing a focus on best practice models and minimal standards for working cross-border" (DoW, 2013). In addition, crisis managers have been proposed as the main target audience in line with the general project objectives². Ethical approval had been obtained from the Ethics Commission of the Department of Psychology and Educational Sciences at Ludwigs-Maximilians-Universität München for the entire project, based on the DoW, prior to its commencement. Thus, no separate ethical approval had to be obtained for this dissertation.

In the following, a few underlying concepts, working definitions and descriptions will be presented, of which most had already formed parts of the theory and rationale presented in the proposal and subsequent DoW. Apart from minor modifications necessary to fit the format of this dissertation, these concepts were developed by, or at least in agreement with, the project consortium. They will be referred to throughout sections of this dissertation, since they form the general theoretical background or research context.

1.1.2 Disaster description

Already in 1986, Korver had found more than 40 scientific definitions of what may constitute a disaster