Community-based Psychosocial Support Research Articles

Barriers and Facilitators to Implementing a Community-Based Psychosocial Support Intervention Conducted In-Person and Remotely: A Qualitative Study in Quibdó, Colombia.

Community-based psychosocial support group (CB-PSS) interventions using task-shifting approaches are well suited to provide culturally appropriate services in low- and middle-income countries. However, contextual barriers and facilitators must be considered to tailor interventions effectively, particularly considering the challenges introduced by the COVID-19 pandemic. We explore the barriers, facilitators, and psychosocial changes associated with implementing a CB-PSS group intervention delivered by local lay providers to conflict-affected adults in Quibdó, Colombia, using both in-person and remote modalities. Data were analyzed from 25 individual interviews with participants and a focus group discussion involving staff members, including 7 community psychosocial agent facilitators and 2 mental health professional supervisors. The analysis used a thematic approach grounded in a descriptive phenomenology to explore the lived experiences of participants and staff members during implementation. Participant attendance in the in-person modality was compromised by factors such as competing work and family responsibilities and disruption caused by the COVID-19 pandemic. Participants in the remote modality faced challenges concerning unstable Internet connectivity, recurrent power outages caused by heavy rain, distractions, interruptions, and threats to confidentiality by family and coworkers. Despite these challenges, data revealed key contextual facilitators, including the community-based knowledge of facilitators and integration of traditional practices, such as the comadreo (informal talks and gatherings). Respondents shared that the CB-PSS groups promoted stronger community relationships and created opportunities for participants to exchange peer support, practice leadership skills, develop problem-solving skills based on peers' experiences, and enhance emotional regulation skills. Differences and similarities across in-person and remote modalities are discussed, as are key considerations for practitioners and policymakers.

Feasibility, acceptability and preliminary effectiveness of a community-based group psychosocial support model for conflict survivors in Colombia: An assessment of in-person and remote intervention modalities during the COVID-19 pandemic

Abstract Background Community-based psychosocial support (CB-PSS) interventions utilizing task sharing and varied (in-person, remote) modalities are essential strategies to meet mental health needs, including during the COVID-19 pandemic. However, knowledge gaps remain regarding feasibility and effectiveness. Methods This study assesses feasibility, acceptability and preliminary effectiveness of a CB-PSS intervention for conflict-affected adults in Colombia through parallel randomized controlled trials, one delivered in-person (n = 165) and the other remotely (n = 103), implemented during the COVID-19 pandemic and national protests. Interventions were facilitated by nonspecialist community members and consisted of eight problem-solving and expressive group sessions. Findings Attendance was moderate and fidelity was high in both modalities. Participants in both modalities reported high levels of satisfaction, with in-person participants reporting increased comfort expressing emotions and more positive experiences with research protocols. Symptoms of depression, anxiety and posttraumatic stress disorder improved among in-person participants, but there were no significant changes for remote participants in comparison to waitlist controls. Implications This CB-PSS intervention appears feasible and acceptable in both in-person and remote modalities and associated with reduction in some forms of distress when conducted in-person but not when conducted remotely. Methodological limitations and potential explanations and areas for future research are discussed, drawing from related studies.

Strategies to improve the implementation and effectiveness of community-based psychosocial support interventions for displaced, migrant and host community women in Latin America.

As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n=77) and facilitators (n=30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study's intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.

Implementing a nurse-led screening clinic for symptom distress with community-based referral for cancer survivors: A feasibility study.

This prospective, single-arm, pragmatic implementation study evaluated the feasibility of a nurse-led symptom-screening program embedded in routine oncology post-treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community-based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress. Using the modified Edmonton Symptom Assessment System (ESAS-r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate-to-severe symptom distress were referred to a nurse-led community-based symptom-management program involving stepped-care symptom/psychosocial management interventions using a pre-defined triage system. Reassessments were conducted at 3-months and 9-months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS-r score change over time. Overall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS-r symptom as moderate-to-severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS-r scores improved significantly over time (p<0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3-month post-baseline, an additional 72(22%) recovered at 9-month post-baseline, while 43(12.2%) had resumed ESAS caseness at 9-month post-baseline. Nurse-led SDS programs with well-structured referral pathways to community-based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.

A Phenomenological Study on the Reintegrating Experiences of Prison Torture Survivors into the Community in Gondar, Ethiopia

This phenomenological study explores the reintegrating experiences of nine prison torture survivors in the community of Gondar, Ethiopia. Data were collected through in-depth interviews and then thematically analyzed, revealing three major themes: the nature of reintegration, personal challenges of integration, and available supports for reintegration. The findings revealed prison torture survivors’ successful integration was based on their community social bonds. Poorly reintegrated prison torture survivors gradually become violent and committed other crimes. Providing community-based psychosocial support and well-organized social services is necessary for the well-being and sustainable reintegration of prison torture survivors into the community.

Piloting a community-based psychosocial group intervention designed to reduce distress among conflict-affected adults in Colombia: a mixed-method study of remote, hybrid, and in-person modalities during the COVID-19 pandemic

BackgroundCommunity members in Quibdó (Choco, Colombia) are highly vulnerable to psychosocial problems associated with the internal armed conflict, poverty, and insufficient public services, and exacerbated by the COVID-19 pandemic. A pilot study was conducted with conflict-affected adults in Quibdó to assess feasibility and outcomes of a community-based psychosocial support group intervention using three different intervention modalities: in-person, remote (conducted online), and hybrid (half of sessions in-person, half-remote). This group model integrated problem-solving and culturally based expressive activities and was facilitated by local community members with supervision by mental health professionals.MethodsThis study utilized a mixed-explanatory sequential design (a quantitative phase deriving in a qualitative phase) with 39 participants and 8 staff members. Participants completed quantitative interviews before and after an eight-week group intervention. A subset of 17 participants also completed in-depth qualitative interviews and a focus group discussion was conducted with staff at post-intervention.ResultsFrom pre- to post-intervention, participants in all modalities demonstrated improved wellbeing and reduced symptoms of generalized distress, anxiety, depression, and posttraumatic stress. Use of coping skills varied across modalities, with remote groups associated with a decrease in some forms of coping, including use of social support. In qualitative interviews and the focus group discussion, participants and staff described logistical challenges and successes, as well as facilitators of change such as problem resolution, emotional regulation and social support with variations across modalities, such that remote groups provided fewer opportunities for social support and cohesion.ConclusionsResults offer preliminary evidence that this model can address psychosocial difficulties across the three modalities, while also identifying potential risks and challenges, therefore providing useful guidance for service delivery in conflict-affected settings during the COVID-19 pandemic and other challenging contexts. Implications of this study for subsequent implementation of a Randomized Control Trial (RCT) are discussed.

Community-based Psychosocial Support for Orphan and Vulnerable Children living in an Orphanage

Children and people living in orphanages are a high-risk group vulnerable to psychosocial problems. Individual who lived in this community are not only orphans but also children and people from low-income families. This group could be perpetrators, witnesses and victims of bullying and other misbehavior lead to mental health and psychosocial problems that are carried out directly, both in the orphanage and in the school where they involved with. This community service aims to improve mental health status of children and people at the Al Husna Orphanage, Dau District, Malang Regency through training of early detection, prevention and early treatment for psychosocial problems through implementation of psychosocial intervention and counseling. When people live in together with other people from different backgrounds, many things triggered to conflict among them. Mental health on students were easily distracted. The results are that they have experienced risk for suicide, hallucination, delusion, anxiety, and social isolation. The manager of the orphanage and the teachers did not understand the early sign, symptoms and treatment then it followed by the psychology issues among staff and the teachers. Through the empowerment program that has been carried out by dealing with the orphan and vulnerable children, socialization and training regarding psychological well-being, early detection, prevention, and treatment could be well-implemented during their activity of daily living. They can detect the deviations early and arrange prevention lists as well as sustainable step for upcoming moment. Most of the children and people were not aware of the problem mental health issues around them as well as prevention and early treatment. People in the orphanage play an active role during outreach activities, training, counseling and focus group discussions.

Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions.

Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations. We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions. In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support. Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture. We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.

Adaptation under strain: an ethnographic process evaluation of community-based psychosocial support services for refugee claimants during the height of the COVID-19 pandemic in Montreal, Canada.

During the first 2 years of the COVID-19 pandemic in Canada, tens of thousands of refugee claimants faced worsened resettlement stress with limited access to services. Community-based programs that address social determinants of health faced significant disruptions and barriers to providing care as a result of public health restrictions. Little is known about how and if these programs managed to function under these circumstances. This qualitative study aims to understand how community-based organizations based in Montreal, Canada, responded to public health directives and the challenges and opportunities that arose as they attempted to deliver services to asylum seekers during the COVID-19 pandemic. We used an ethnographic ecosocial framework generating data through in-depth semi-structured interviews with nine service providers from seven different community organizations and 13 refugee claimants who were purposively sampled, as well as participant observation during program activities. Results show that organizations struggled to serve families due to public health regulations that limited in-person services and elicited anxiety about putting families at risk. First, we found a central trend in service delivery that was the transition from in-person services to online, which presented specific challenges including (a) technological and material barriers, (b) threats to claimants' sense of privacy and security, (c) meeting linguistic diversity needs, and (d) disengagement from online activities. At the same time, opportunities of online service delivery were identified. Second, we learned that organizations adapted to public health regulations by pivoting and expanding their services as well as fostering and navigating new partnerships and collaborations. These innovations not only demonstrated the resilience of community-organizations, but also revealed tensions and areas of vulnerability. This study contributes to a better understanding of the limits of online service delivery for this population and also captures the agility and limits of community-based programs in the COVID-19 context. Its results can inform decision-makers, community groups and care providers to develop improved policies and program models that preserve what are clearly essential services for refugee claimants.

Implementing psychosocial support models in contexts of extreme adversity: lessons from a process evaluation in Colombia.

High quality investments during early childhood allow children to achieve their full potential by setting developmental foundations. However, challenges in the scale-up of evidence-based interventions make across-the-board implementation a non-trivial matter. Moreover, extreme contextual conditions -such as community violence, forced displacement, and poverty- impose a double threat. First, by directly affecting early childhood development (ECD), forced displacement and exposure to violence during early childhood, coupled with deficits in nurturing relationships, can trigger toxic stress, affecting children's mental health and social and emotional learning. Second, contexts of extreme adversity exacerbate common implementation pitfalls in the scale-up of interventions. Recognizing and documenting "what it takes" to successfully implement "what works" can contribute to the expansion and effectiveness of evidence-based programs that promote ECD in these settings. Semillas de Apego (SA, onward), a community-based psychosocial support model for caregivers, materialized as a strategy to promote ECD in communities affected by violence and forced displacement. This article presents the results of the process evaluation of SA during the 2018-2019 implementation in Tumaco, a violence ridden municipality in the south-west border of Colombia, South America. In this phase, the program reached 714 families, 82% direct victims of violence and 57% were internally displaced. The process evaluation combined qualitative and quantitative methodological approaches to produce evidence of factors that promoted implementation quality. Findings identified salient components of the program that promoted the program's acceptability, adoption, appropriateness, fidelity and sustainability: a rigorous cultural adaptation; well-structured team selection and training methodologies; and a team support and supervision protocol to provide continuous capacity building and prevent burn-out and other occupational hazards common among professionals in mental health and psychosocial support interventions. The statistical analysis using monitoring data identified key predictors of the dosage delivered (a measure of fidelity). Evidence suggests that initial attendance to the program and observable characteristics -such as educational attainment, violence victimization and employment status-predict a successful compliance (in terms of dosage to benefit from the program). This study provides evidence for the development of structural, organizational, and procedural processes for the adoption, appropriate adaptation, and high-fidelity delivery of psychosocial support models delivered in territories affected by extreme adversity.

Ensuring equity in mental health and psychosocial support during the COVID-19 pandemic and beyond

Populations affected by armed conflict and other humanitarian crises are at elevated risk for mental health problems. While the COVID-19 pandemic has had broadly deleterious effects on livelihoods, economic well-being, and population health worldwide, vulnerable groups have been disproportionately impacted by the pandemic. Providing mental health and psychosocial support (MHPSS) services during these times to vulnerable groups, especially in low- and middle-income countries and humanitarian settings, is essential. In an effort to comply with the public health response to the pandemic and mitigate COVID-19 transmission, significant implementation adaptations were made to service delivery during the pandemic. This short report describes several strategies to ensure that equity was central to these adaptations and public health responses, and provides recommendations for ensuring continuity of this progress post-pandemic. Examples and key lessons learned are given related to strategies to increase access to MHPSS services, improve meaningful stakeholder engagement, develop and support community networks, and implement community-based psychosocial support groups. They come from diverse settings of Bangladesh, Colombia, Ecuador, and Lebanon. The COVID-19 pandemic has highlighted the importance of preventing and treating MHPSS issues. It also has created opportunities for innovative programming to address overlooked problems, improve the quality of services provided, and increase focus on equity. It is vital that we use the momentum and attention generated around MHPSS services during the COVID-19 pandemic to continue to build and improve existing MHPSS services in more equitable ways for vulnerable populations.

"If it weren't for my traditional healer, I would be dead": Engaging traditional healers to support people living with HIV in rural Mozambique.

Across rural sub-Saharan Africa, people living with HIV (PLHIV) commonly seek out treatment from traditional healers. We report on the clinical outcomes of a community health worker intervention adapted for traditional healers with insight into our results from qualitative interviews. We employed a pre-post intervention study design and used sequential mixed methods to assess the impact of a traditional healer support worker intervention in Zambézia province, Mozambique. After receiving a positive test result, 276 participants who were newly enrolled in HIV treatment and were interested in receiving home-based support from a traditional healer were recruited into the study. Those who enrolled from February 2016 to August 2016 received standard of care services, while those who enrolled from June 2017 to May 2018 received support from a traditional healer. We conducted interviews among healers and participants to gain insight into fidelity of study activities, barriers to support, and program improvement. Medication possession ratio at home (based on pharmacy pick-up dates) was not significantly different between pre- and post-intervention participants (0.80 in the pre-intervention group compared to 0.79 in the post-intervention group; p = 0.96). Participants reported receiving educational and psychosocial support from healers. Healers adapted their support protocol to initiate directly observed therapy among participants with poor adherence. Traditional healers can provide community-based psychosocial support, education, directly observed therapy, and disclosure assistance for PLHIV. Multiple factors may hinder patients’ desire and ability to remain adherent to treatment, including poverty, confusion about medication side effects, and frustration with wait times at the health facility.

Implementation of a Community-Based Psychosocial Support Focal Point Response for Internally Displaced Persons in Myanmar During COVID-19.

BackgroundIn response to the COVID-19 pandemic, the Global Mental Health research group at Johns Hopkins School of Public Health worked with three local partner organizations in Myanmar to develop a psychosocial support (PSS) program that could be delivered by community-based focal points in internally displaced persons camps. This PSS program was designed to be delivered in communities with limited access to regional mental health services due to pandemic travel restrictions. The content of the PSS program was based on materials from an ongoing Common Elements Treatment Approach (CETA) mental health program; CETA counselors based in the three partner organizations were available to provide telephone-based CETA counseling. In April 2020, the partners organizations recruited and trained PSS focal points in 25 IDP camps to establish a multi-tiered system of MHPSS supports.ImplementationThe PSS program including psychoeducation handouts focused on stress and coping during COVID-19 and skills for cognitive restructuring (i.e., changing unhelpful thoughts) in simplified terms, audio recordings of the content of these handouts and referral opportunities for telephone-based services by CETA counselors located outside of the camps. PSS focal points distributed the handouts, had the recordings played via radio and loudspeaker, and were available to answer questions and provide access to a PSS program phones to connect with the CETA counselors. After 6 months of implementation, program monitoring logs were reviewed and a cross-sectional evaluation was conducted to assess the PSS program's reach, understanding, and perceived utility.EvaluationForty-one focal points implemented the PSS program in 25 IDP camps in Kachin and northern Shan States. From May to September 2020, the focal points distributed handouts to 5,725 households and reported 679 visits by IDPs, including facilitating 332 calls to a CETA counselor. Data from the program evaluation (n = 793 participants) found high levels of handout readership and perceived utility of the information, and good comprehension of the content and application of skills.DiscussionFindings suggest that provision of a multi-tiered MHPSS program, with PSS focal points providing direct information and linkages to further mental health services via telephone, was feasible despite the constraints of the pandemic. Utilizing camp-based focal points was acceptable and successful in delivering basic psychosocial supports to a broad population while serving as points of contact for individuals who wanted and needed telephone-based counseling services.

Determinants of visits of cancer patients to Dutch Community Based Psychosocial Support Centres (CBPSCs)

Aim: The psychosocial support for cancer patients in the mental health care is often limited because of difficulties in access and the expense to patients. In response, informal regional support centers have been developed in the Netherlands called “Community-based Psychosocial Support Centres (hereinafter: CBPSCs) for cancer patients and relatives. They offer supporting complementary activities and professional psychological help which are easily accessible and free of charge. We studied the use (frequency, duration and future use) and the determinants of the visits to CBSPCs. Method: Visitors covering 701 cases from 25 CBPSCs filled-out a web-based questionnaire, answering questions about how often they contacted CBPSCs (frequency, duration and future use) and which personal factors, mainly based of the ASE model, influenced the use of CBPSCs. Also, the well-being of the patient, the evaluation of the visits and the significance of the support received were studied as dependent variables, in addition to the role of the ASE factors, applying multivariate analyses. All sum scores showed a strong internal consistency. Results: Most patients did not know what CBPSCs are or where to find them. About one-fifth was alerted by family, friends and acquaintances. Another 20% was informed about CBPSCs by hospital oncology nurses and through leaflets. Patients rarely reported being referred by their GPs and medical specialists. Health care providers in hospitals were much better informed about CBPSCs, referring approximately half of their patients to CBPSCs. Around two thirds of the patients visited the CBSPC once a week for 2 to 3 hours and intended to continue these visits in years to come. Present use generally showed that the most important determinants are the attitude towards the visits, whether the patient is a recent visitor, the patient’s perceived significance of the visits and having a socially-inactive lifestyle. Conclusions: The study confirms the high value that this type of organisation provides in informal support in cancer care. The CBPSCs need to improve their visibility in the healthcare system through more public campaigns and better information to patients. More countries should introduce and stimulate this type of easily-accessible, cheap, effective and highly-valued supportive care centres, and explore the needs of patient and family members.

Despair and Suicide-Related Behaviours in Palorinya Refugee Settlement, Moyo, Uganda

This descriptive study illustrates the multitude of intertwining factors contributing to suicidal ideation and attempts, and deaths by suicide among South Sudanese refugees in Moyo/Obongi Palorinya settlements in northern Uganda. It was conducted from 2019 to 2020 due to escalating rates of suicide attempts and deaths by suicide noted in a rapid assessment by Lutheran World Federation mental health and psychosocial support (MHPSS) workers. This study aimed to better understand factors contributing to suicidal ideation and attempts among refugees, to tailor MHPSS interventions and prevent potential escalation of suicidality across the region, including nearby refugee hosting districts in Adjumani/Lamwo. Data collection techniques included key informant interviews, focus group discussions, case studies and review of the lead author’s therapy recovery notes. The findings highlighted the following factors contributing to escalating suicidality among the refugees: war stressors (experiencing and witnessing violent acts), daily stressors, social fragmentation, normalised violence, social isolation, lack of economic opportunities, loss of assets and loss of confidence and hope, among others. The assessment found that the spiking trend of increased suicidal behaviour is apparently unique to Moyo/Obongi, compared to neighbouring settlements, but emphasises the need for monitoring and preventive interventions in neighbouring districts. The psychosocial as well as economic impact of a reduction in funding for MHPSS programming is underlined, emphasising the need for long-term funding to consolidate programme effects and respond to realities on the ground. Community-based psychosocial support interventions provided by Lutheran World Federation are described that have subsequently helped to mitigate and respond to the escalating trend in suicidality and reflections given to strengthen the ongoing response with lessons learned for other contexts.

Impact of Visiting Community-Based Psychosocial Support Centres on the Well-Being of Cancer Patients: Exploration of Evaluation and Effects

Aim: Community-based psychosocial support centres for cancer patients and their relatives (CBPSCs) in the Netherlands offer easily accessible contacts with fellow patients and support by trained volunteers and/or professionals. We studied if the participants in the social support and/or therapy activities are satisfied with these services and if the visits do affect their well-being in terms of bodily and emotional health and their health quality of life (HQoL).Methods: In 25 CBPSCs, 701visitors filled out a web-based questionnaire about their experiences with CBPSCs. Within this sample, 203 participants answered a part of the questionnaire again after 3-5 months about their personal characteristics, the type participation at the visits, their satisfaction with the offered activities, the experienced health complains, and three HQoL questions of the EORTC measure.Results: The study confirms the significance of CBPSCs contacts with fellow patients, resulting in satisfaction with the increased communication about their illness and talks about their problems. The results show further that after a 3-5 months the health complains did not change, but the HQoL decreased significantly for all visitors, except for more serious ill patients in comparison with less ill patients. Discussion and conclusion CBPSCs play an important and highly evaluated role in psycho-oncological support. The visit for serious ill patients may function as a buffer for preventing the decrease of their HQoL. Insight in effects of such visits is still limited in other studies. Differences in the health care organization restrict the comparability with the CBPSCs in other countries. More studies are needed to show the long-term effects of CBPSCs visits.

VESPRA Enabling Communities through a Community Based Psychosocial Support Program 1965-1970

The objective of this report is to share with the reader, an early method of community mobilization in a then resource poor territory of the United States: Puerto Rico. The program initiated the mobilization method by recruiting youth to visit communities, engage its citizens in conversations that resulted in prioritization of problems, identification of community capitals, and action. The U.S. Federal Government provided funding for the program from 1965-1971. Importance of the study: Community mobilization is gaining importance within the scientific areas of psychosocial support and community mental health as the world faces natural disasters, movement of people and climate change. While this study looks at events that happened in the 1960’s the results of this strategy and community experiment are used today in programs such as VISTA in the United States and Humanitarian Agencies providing community-based programs to poor people. Method for data collection: This is a qualitative study and so a multi method approach for collection, interpretation and analysis of data relies on the facts as gathered from a desk study of the U.S. Government, and Government of Puerto Rico Archives as well as trying to make sense of events on the ground through participant observation and interviews with former volunteers, paid staff and participant communities (1965-1971), and offering examples from newspaper reports, of the period, to relate to the reader the meaning people gave to these events in real time. Reporting of Findings: The findings for this study are reported sequentially from 1965 to 1971. The format is: 1) the fact, 2) impact, and 3) event. The findings include explanation of training methods, recruiting of personnel, administrative tasks, and the consequences on the ground as reported in newspapers, or follow-up quarterly reports from the field. The most important event was the formation of the Poor People’s Council, and their subsequent participation in Boards of programs that impacted their future. Footnotes are used within text to represent additional content that supplements the text.

Monitoring Adverse Psychosocial Outcomes One and Two Years After the Lac-Mégantic Train Derailment Tragedy (Eastern Townships, Quebec, Canada).

In July 2013, a train carrying 72 cars of crude oil derailed in the town of Lac-Mégantic (Eastern Townships, Quebec, Canada). This disaster provoked a major conflagration, explosions, 47 deaths, the destruction of 44 buildings, the evacuation of one-third of the local population, and an unparalleled oil spill. Notwithstanding the environmental impact, many citizens of this town and in surrounding areas have suffered and continue to suffer substantial losses as a direct consequence of this catastrophe. To tailor public health interventions and to meet the psychosocial needs of the community, the Public Health Department of Eastern Townships has undertaken repeated surveys to monitor health and well-being over time. This study focuses on negative psychosocial outcomes one and two years after the tragedy. Two cross-sectional surveys (2014 and 2015) were conducted among large random samples of adults in Lac-Mégantic and surrounding areas (2014: n = 811; 2015: n = 800), and elsewhere in the region (2014: n = 7,926; 2015: n = 800). A wide range of psychosocial outcomes was assessed (ie, daily stress, main source of stress, sense of insecurity, psychological distress, excessive drinking, anxiety or mood disorders, psychosocial services use, anxiolytic drug use, gambling habits, and posttraumatic stress symptoms [PSS]). Exposure to the tragedy was assessed using residential location (ie, six-digit postal code) and intensity of exposure (ie, intense, moderate, or low exposure; from nine items capturing human, material, or subjective losses). Relationships between such exposures and adverse psychosocial outcomes were examined using chi-squares and t-tests. Distribution of outcomes was also examined over time. One year after the disaster, an important proportion of participants reported human, material, and subjective losses (64%, 23%, and 54%, respectively), whereas 17% of people experienced intense exposure. Participants from Lac-Mégantic, particularly those intensely exposed, were much more likely to report psychological distress, depressive episode, anxiety disorders, and anxiolytic drug use, relative to less-exposed ones. In 2015, 67% of the Lac-Mégantic participants (76% of intensely exposed) reported moderate to severe PSS. Surprisingly, the use of psychosocial services in Lac-Mégantic declined by 41% from 2014 to 2015. The psychosocial burden in the aftermath of the Lac-Mégantic tragedy is substantial and persistent. Public health organizations responding to large-scaling disasters should monitor long-term psychosocial consequences and advocate for community-based psychosocial support in order to help citizens in their recovery process.

Learning Together to Heal: Toward an Integrated Practice of Transpersonal Psychology, Experiential Learning, and Neuroscience for Collective Healing

This essay brings together complementary insights from transpersonal psychology, experiential learning, and neuroscience to develop an integrated framework of psychosocial healing in societies affected by conflict and trauma. While transpersonal psychology examines the spiritual and transcendental aspects of psychosocial wellbeing, research on experiential learning examines how people learn from direct experience. Recognizing that both are useful for psychosocial healing, the first part of the essay explores how the two sets of activities can complement each other. Of particular interest is the role of transpersonal exercises such as yoga and meditation, as well as the purposeful use of experiential learning techniques such as storytelling, rituals, and metaphors. To examine the scientific foundations of these activities for psychosocial healing, findings from neuroscientific studies supported by the latest technology of neuroimaging will be discussed. The final section of the essay introduces a brief case study of the Ubuntu Center for Peace, a Rwanda-based nongovernmental organization dedicated to community-based psychosocial support. The case study illustrates how the proposed integrative framework can be used to tackle a real-world context of conflict and trauma. It includes preliminary findings from a program evaluation of the community-based social healing initiative that the Ubuntu Center carried out in Rwanda.

Psychosocial Support: A Tool for Empowering Communities in Puerto Rico after a Catastrophic Event

1. Abstract Puerto Rico was affected by Hurricane Maria in September 2017, and today, hundreds of thousands of people are experiencing fear, panic attacks, anxiety, and night terrors as a result of that hurricane. A community-based psychosocial support structure to be integrated into the National Disaster Response Plan of Puerto Rico is proposed herein.