Lay community counsellor

Transitory Communities

A community may be defined as a group of people with a sense of common history, language, race, mores, values, attitudes, knowledge structures, and purpose. However traumatic events, such as a natural disaster, spawn new “transitory communities” and establish new dynamics that transcend natural communities. In such transitory communities the blow is not just to the individual psyche, but to the tissues of social life and the bonds that bind these communities together.

Evolution of the Lay Community Counselor Model for large scale disasters

The Lay Community Counselor Model for post-disaster crisis intervention was developed by Dr. Gauthamadas in face of the challenging situation faced by the Academy for Disaster Management Education Planning and Training (ADEPT), in the aftermath of the Tsunami. The 51 Tsunami affected villages in ADEPT's operational area of Cuddalore District, Tamilnadu, are geographically removed from urbanization. These villages had not been exposed to the effects of Globalization before the Tsunami. The fishing community, in these villages, is an “ethnocentric community” that does not broach interaction even with neighboring communities except for their trade. Ethnocentricism has been recognised as the single most powerful impediment to trauma counseling (Chemtob,1997). Ethnocentric communities tend to assume that their experience of the world “is the world”. An influx of the “outside world”, such as in the aftermath of a natural disaster, could, therefore, be an impediment or an advantage. It could either make the community withdraw into itself , or develop a bond with the outside world that has seen and experienced a similar peril. According to the National Organization for Victim Assistance (NOVA), Washington, D.C, the likelihood of defensiveness in such communities will be high, based on pre-exposure conditioning. Therefore the biggest obstacle to any kind of crisis intervention was the community’s lack of openness to “outsiders”.

Ethnocentrism is central to understanding help-seeking behaviour, what the people in the community define as a "problem," what the individual understands as the causes of psychological difficulties, and the unique, subjective experience of traumatic stress symptoms (Parsons, 1985

While the threats to life associated with psychological trauma are universal, the perception and interpretation of the threats varies across cultures including: the perception of what type of threat is traumatic, the interpretation of the threat's meaning, the nature of the expression (presentation) of symptoms in response to such threats, the cultural context of the responses of traumatized people, as well as the cultural responses by others to those who have been traumatized, and the culturally prescribed paths to recovery from experiencing life-threatening events. Finally, it is also useful to consider the process by which the exposure of individuals and groups to traumatic events is made useful for the entire culture (The National Organization for Victim Assistance, 2003). According to Chemtob (1997), all this is not possible to grasp for new comers who enter the community for the first time in the aftermath of a disaster, and may not be possible even for those who are professionally trained, to understand in the emergency situation.

Another barrier to counseling in the aftermath of a disaster is language. Language differences and patterns among diverse cultures are common and complicated. The national languages, and even the nuances of local dialects spoken, weave into the delicacy of working with local communities, who are little exposed to the world outside. One can learn Spanish, English or Russian but not understand the synthesis of verbs, nouns, adjectives, adverbs and phrases that result in common understandings among those who are a part of the culture. Languages including regional dialects dictate how one forms ideas, translates sensory perceptions, and interprets the world. The phrasing, silences, speed of delivery, and pitch or tone of voice, even when using the same word or phrase, means different things to different people and form the crux of the counseling skills. (The National Organization for Victim Assistance, 2003).

While interpreters can be used, training is needed for speaking through an interpreter. Interpreters or translators contribute to the ambiance of any crisis setting. They become the interpreters not only of the survivor but also of the intervener. In some cultures it may be appropriate for them to translate with additional flair. In other cultures such interpretation may be offensive. In the counseling situation such differences alter the healing relationships (The National Organization for Victim Assistance, 2003) In any case such training was not possible in the immediate aftermath of the Tsunami.

In a post disaster setting the counselor, besides meeting the basic needs of the affected individuals, needs to understand the grieving process and psychological trauma, and the needs of the survivors in a culturally appropriate manner. Also counseling of disaster survivors may require to be undertaken in informal settings. A supportive conversation or a focused problem-solving session during a casual home visit could very well be a counseling session.

Last, but not the least, counseling has proved a challenge in India even to contemporary Indian families (Kashyap 2004). While the average Indian is ready to accept physical explanations for symptoms of psychological trauma, they are less likely to attribute psychological origins to them and therefore less amenable to formal counseling.

Lay Community Counselors

Lay counselors are members of the community who are trained to provide a specific service or to perform certain limited activities. The concept of lay / community counselors is not new.

A large number of agencies outside of India, particularly in the United States and United Kingdom depend on the volunteer sector for counseling services (Bond, 1993). Therefore the strategy adopted by ADEPT was of community based counseling using volunteer lay community counselors who share a significant aspect of their background – culture, language and experience primarily - with the affected community .

Members from the affected communities, and others closely interacting with the local population such as teachers, government personnel etc., can be highly effective to reach out as community counselors as they represent the groups they are serving, and can readily gain access to them. This model works by strengthening the existing social support networks.

Lay counselors have been used in counseling of drug addicts, people living with or at risk for HIV / AIDS etc. Experiences have showed that paraprofessional counselors, who would work effectively in their home-community, can be produced with short-term training. Gluckstern (1972) reported success of a 60 hour training of parents as lay counselors. The study evaluated the effect of the program on the trainees with regard to knowledge and attitudes, the effect of the training upon the trainees with regard to counseling skills acquisition, and the role the trainees played in the community seven months after training. The results of the study indicated that the trainees did in fact learn the skills taught and did maintain them over a period of time. Peer counselors have been found to be more effective than regular professional care (Malchodi et al, 2003)

Lay community counselors overcome the issues of entry into community, those related to ethnocentrism, and the shortage of resources, by training members from within the affected community. These same counselors are especially effective as they are involved in the relief and recovery operations after the disaster.

Creating Lay Community Counsellors

Keeping in mind the situational limitations ADEPT's goals of creating Lay Community Counselors were:

*To train local volunteer lay community counselors in immediate crisis response and basics of trauma counseling.
*To help the community counselors to support survivors in their efforts to respond to the effects of Tsunami.
*To assist the counselors plan their activities in the aftermath of the Tsunami.

The participants were trained in the psychological effects of disasters, and simple guidelines with sample techniques to handle them, including vignettes and an assignment to design sample action plans targeting different situations. Training methodology was short interactive lectures combined with interactive group work and participatory plenary sessions. Training duration was three days. The entire training was conducted in the vernacular using simple language and avoiding technical terms and jargon.The design of the program included the preparation of the training module, identification of the target group, planning duration of the training and its methodology and post training professional support. The module was formulated for purposes of exigency and the material adapted from several open source documents.

The training team included a psychiatrist, a psychologist, a trained counselor.

The participants of the program were several members associated with the local communities, and grass root level leaders, especially those who have already been providing supportive service to the affected community prior to the Tsunami such as:

*Village Health Nurses and Health Inspectors
*Teachers
*Self Help Group members
*Youth Leaders
*Leaders of faith based organizations
*Community leaders
*Disaster Response workers

The expected outcomes of the training included basic skills of counseling such as the capacity:
*To understand reactions to trauma,
*To listen and help survivors to ventilate,
*To help survivors find privacy for the expression of emotions
*To support survivors in their efforts to achieve a sense of emotional safety by reassuring them that their reactions are acceptable and not uncommon,
*To help survivors begin to take control of the events going on around them
*To assist survivors in handling the practical issues that will face them in the aftermath of the Tsunami.
*To identify survivors with severe psychological problems and refer them to qualified experts/professionals.

The Training was designed for a three-day period to quickly equip the volunteer community counselors with the basic skills of counseling. Thereafter additional support and hand holding was provided through fortnightly follow up half-day sessions over a three-month period that was participatory and interactive.

The Community Counselors took the initiative to sit and talk with the survivors, listen to them and be a part of their loss and this was immensely helpful. The survivors needed someone to empathize with them and it was not always the monetary part that mattered. The community counselors provided counsel by:
*handling the bereaved through supportive interaction,
*handling the children through play, and interactive and creative activities such as enacting plays, composing poems, singing songs, dancing and music etc. with the themes of “goodness of nature”, “tsunami is transient”, “we shall overcome” etc.
*public education and awareness of the nature of the tsunami
*problem solving and supportive activities

Twice monthly follow up meetings showed that the training produces efficient and expeditious results. The referral pattern was good and it was observed that the community counselors developed culturally appropriate interventions that were effective and methodologically diverse for every group. These have been documented as case studies. The trained volunteer community counselors helped to provide structure and calm in the midst of the chaos in the aftermath of the Tsunami.

The methods used among the adult population were case specific, innovative and adaptive such as:
*the ten year old boy who was brought out of his grief (for the six year old sister snatched from his hands by the Tsunami) by being asked to mother a plant.
*systematic de-sensitisation of the fear of the sea by regular visits to the backwaters for a bath
*diverting attention from the tragedy by engaging the affected person in activity to restore normalcy to life.

The examples of cases referred to professionals were also indicative of the confidence of the community counselors – both in the counseling process and in realising their own limitations The design of the program and the associated advantages of the model were many including:
*Less dependence on experts
*Cost effectiveness
*Ensured local community participation
*Ready entry points with the additional benefits of shorter time frames, easier
*Identification of needs, easy rapport, and effective communication,
*Enhanced stature of the community counsellors in the affected communities due to their continued presence and participation in recovery and reconstruction activities.

Effectiveness of Lay Community Counselors

Focus group evaluations conducted 8 months and 16 months after the training elicited the long-term effects of the training from core groups of community counselors, including the knowledge and attitudes, the effect of the training upon the trainees with regard to counseling skills acquisition, and the role the trainees played in the community immediately after the training and at the time of evaluation.

Several post training benefits of the training were elicited. All those who had undergone training felt that the training had a positive impact on the quality of ameliorative assistance provided by them immediately after the tsunami, when compared to the assistance given by their colleagues and peers who had not been trained.. Many felt they could cope better both personally and professionally. They felt that the training enhanced their skills in interpersonal relationships and helped them to be more insightful in their work. The major points that were repeatedly mentioned by the majority of participants of the training include the following:

*A capacity to reach out to communities better than in the past.
*The confidence that they could translate learning into practice.
*A distinct difference between those who had been trained and those who had not. While those who had been trained coped well with post tsunami daily life crisis, those who had not floundered.
*Personal benefit as they ventilated during the training, rendering their own healing process much faster.
*The internal transformation produced by engaging the adults in re constructive activities.
*The acquired ability to train co-workers on psycho-social intervention
*The benefits of “venting” their feelings and sharing their experience with other community counselors during the post training contact programs, that helped them cope with the stress that came with handling grief stricken survivors.
*The perceptible sharpening of innate qualities that are a natural part of any individual such as listening skills, use of questions, even reflective silences

All participants felt that the duration of the training in the opinion was adequate for the work done. The study also indicated that even 16 months after the Tsunami those who had not undergone the training were unable to cope with crises that they were subsequently faced with , while those who were trained could narrate in depth how they handled subsequent crisis situations. More than half of the trainees felt competent to identify and refer cases they were unable to handle to experts and several who were from the Public health department were aware of the services available and frequently referred them to experts.

The model now needs to be tested in other emergency situations

See also

* List of counseling topics

References

Bond, Tim (1993). Standards and Ethics for Counselling in Action. (Sage, London.)

Chemtob, C.M., Posttraumatic Stress Disorder, Trauma, and Culture, International Review of Psychiatry, Volume 2, Chapter 11

Community Crisis Response Team Training Manual, The National Organization for Victim Assistance, 2003

De Vries, M.W., Trauma in Cultural Perspective, in van der Kolk, B.A., McFarlane, A.C. and Weisreth, L., Traumatic Stress.

DeWolfe, Deborrah J, Training Manual for Mental Health and Human Services Workers in Major Disasters, Ed: Nordboe, Diana, Substance Abuse and Mental Health Services Administration, USA, 2000.

Ehrenreich, John H. and McQuaide Sharon, Coping with disasters: A guidebook to psychosocial intervention, Revised edition, Center for psychology, State University of New York, 2001

Gauthamadas U., A Model for Crisis Intervention in Large Scale Disasters using Lay Community Counsellors [http://en.wikipedia.org/wiki/
]

Gluckstern, Norma B. Parents as Lay Counselors: The Development of a Systematic Community Program for Drug Counseling, Education Reources Information Center, 1972

Kashyap, Lina, Introduction to this Special Issue, International Journal of Advancement of Counselling, 26:4, 2004

New South Wales Institute of Psychiatry, Disaster Mental Health Response Handbook, 2000

Malchodi Carolyn S., Oncken, Cheryl, Dornelas; Ellen A.; Caramanica, Laura, Gregonis, Elizabeth; Curry, Stephen L., The Effects of Peer Counseling on Smoking Cessation and Reduction, Obstetrics & Gynecology 2003;101:504-510

Parsons, E.R., Ethnicity and Traumatic Stress: The Intersecting Point in Psychotherapy, in Trauma and Its Wake, ed. Figley, C.R., Brunner/Mazel: New York, 1985.

Rocky Mountain Disaster Mental Health Institute, Crisis Intervention Training for Disaster workers