Grant Agreement N 07.030601/2006/447903/SUB/A3

Project co funded by the European Commission – Grant Agreement N° 07.030601/2006/447903/SUB/A3''

Report Cologne conference November 29th- December 1st 2007

Town hall of Cologne (November 29/30) and University of Cologne (December 1)

Project Partners:

City of Cologne, Office for International Affaires, Germany

Impact, Dutch Knowledge & Advice Centre for Post-Disaster Psychosocial Care, Amsterdam, The Netherlands

Institute for Clinical Psychology and Psychological Diagnostic, University of Cologne, Germany

Centre for Psychotraumatology, Alexianer-Hospital Krefeld, Germany

Sociedad Española de Psicotraumatología, Estrés Traumático y Disociación, SEPET+D, Madrid, Spain

http://www.eutopa-info.eu/

SEPET+D

1 Project co funded by the European Commission – Grant Agreement N° 07.030601/2006/447903/SUB/A3''

Introduction

This report offers a short overview of the first conference that took place in the framework of EUTOPA. It consists of a general part and three workshop reports. A participant list is also available.

Conference aim

EUTOPA pursues the development of standardization of psychosocial post disaster care and supporting a network of European experts related to this theme. In detail we focused on early intervention for special target groups such as children and social workers, the significants of screening instruments, and the integration of psychosocial aspects in the mid- and long term intervention for survivors of catastrophes and man made disasters.

To make a step forward towards standardization European experts gave keynote speeches and gathered the expertise from the participants in the workshops. On the final day of the conference the experts and delegates from Europe had the chance to present their work to the public audience. We shared the results of the three workshops with mental health professionals, first aid organisations and other vocational groups.

Participants Experts from 18 EU member states were present, in total about 45 people. For more information see the participant list attached.

Keynote speeches Following keynote speeches were presented during the three day conference. The PowerPoint presentations can be downloaded at: www.eutopa-info.eu.

What is the sense of Minimal Standards? Claudia Schedlich, Institute for Clinical Psychology and Psychological Diagnostics, University of Cologne

Multidisciplinary guideline for early psychosocial interventions after disaster, terrorism, and other shocking events. Magda Rooze, director Impact, The Netherlands

Target Group Intervention Program Dr. Robert Bering, Physician-in-Chief, Centre for Psychotraumatology, Alexianer- Hospital Krefeld, Germany

The Omagh bombing and developing an effective psychosocial response

David Bolton, Director of The Northern Ireland Centre for Trauma and Transformation, Ireland.

International Psychosocial activities in the red cross/red crescent Maureen Mooney Coordinator Red Cross European Psychosocial Network, France

Early Intervention programs for children on a pan European level Prof. Dr. William Yule Institute of Psychiatry, Kings College London, United Kingdom

Current developments in disaster psychiatry Prof. Lars Weisaeth Research director of the Norwegian Centre for Violence and Traumatic Stress studies in Oslo, Norway

Workshops In the three workshops we presented the state of the art on three special topics and we worked in an interactive manner to integrate the expertise of the delegates who were present. Detailed reports are available in attach. The three workshops were:

Workshop A: Special target groups A1: Children & Adolescence Chair and keynote: Raija-Leena Punamäki, Finland Referents: Arielle de Ruijter, Netherlands Barbara Juen, Austria William Yule, United Kingdom

A2: Rescue Workers Chair and keynote: Erik de Soir, Belgium Referent: Gisela Zurek, Germany Bruno Brito, Portugal Marc Stein, Luxembourg

Workshop B: Risk factors and screening instruments for trauma related disorders Chair: Ask Elklit, Denmark Referent: Robert Bering, Germany

Workshop C: The Integration of psychological and social strategies in the middle and long term intervention of people affected by catastrophes and/or disasters Chair: Francisco Orengo Garcia, Spain Referent: Stephan Vymetal, Czech Republic Claudia Schedlich, Germany

Conclusions Cologne Conference

In many EU member states important steps towards planning and content of post disaster psychosocial care are being made as we learned from the keynote speeches.

In the Netherlands, recently a multidisciplinary guideline on early psychosocial interventions has been adopted. To explore whether this guideline can function as a framework for other EU countries the next EUTOPA conference will be held in Amsterdam. This guideline is being translated in English, German, French, Spanish, and Italian.

In Germany a screening instrument, the Cologne Risk Index (CRI), has been developed for different target groups such as victims of violence, soldiers, and survivors of terror attack and disaster. The instrument is available by internet (www.plot-info.eu; www.eutopa-info.eu). Screening with the CRI is a crucial part of Target Group Intervention Program (TGIP). According to the risk profile varying intervention measures such as psychological first aid, psychoeducation, diagnosis of PTSD including related disorders, and psychotherapy are standardized in the TGIP (see literature).

The Northern Ireland experience shows, that trauma related disorders are a serious consequence of civil violence, and that investment in mental health offers important solutions for people, families and the community, for the economy and in peace making. There is however a need for evidence based practice services and providing more knowledge and training on trauma-related issues.

The international Red Cross offers all kinds of formal and non formal community- based psychosocial support in areas hit by disaster and conflict. Harmonization of this support is a keyword. The support is evaluated in a cyclic way: assessment, planning, implementation and evaluation are part of every action. The guidance on mental health and psychosocial support in emergency settings of the Inter Agency Standing Committee of the World Health Organization are very helpful in their work.

Children are easily forgotten in disaster. Research is often more expensive because of the more time consuming way of research in young children where you cannot use questionnaires, but strongly needed. Standards for support for children should be integrated in general standards and responses should be properly evaluated. Important research findings on the Teaching Recovery Techniques as developed by the Children and War foundation (Dyregrov and Yule, 2002) show that this program is effective.

In Norway, an extensive study has been conducted after the Tsunami. Now the results are available. Outstanding international experts on post-disaster psychosocial care have formulated 5 empirically supported intervention principles that should guide this work: sense of safety, calming, sense of self- and community efficacy, connectedness and hope (Hobfoll et al, 2007).

In regard to the interactive workshops, they offered important findings and recommendations for the near future:

In relation to children there is a need for guidelines on post disaster psychosocial care, integrated in other manuals, standards, and guidelines. A developmental perspective should be adopted, findings of attachment-studies should be integrated, and parents, schools and communities should be supported. More financial possibilities for research should be created on an EU level.

Rescue workers don’t want to be seen as victims, although their work should be regarded as a high risk profession. Psychosocial support should be offered to them in the first place from their own organizations and colleagues to be acceptable for them.

Interesting discussions on risk factors and screening took place. Most of the delegates considered the use of screening instruments helpful, and the most well used instruments were summarized. Distinction can be made between screening instruments that assess ASD, PTSD or PTSD related disorders such as the CAPS (Clinician Administered PTSD Scales); screening instruments that measure symptoms that are related to PTSD and PTSD related disorders such as IES-R and PTSS-10, and screening instruments that are able to predict the development of PTSD and PTSD related disorders on the basis of risk factors, such as CRI and DARRYL for children from 6-12 years. A need is felt for more research, quantitative as well as qualitative, and on risk factors as well as on protective factors.

On the topic of integration of psychological and social strategies in the mid and long term intervention with people affected by catastrophes and/or disasters important recommendations came out of the questionnaire the delegates completed and from the related discussions.

The first is “collaboration and clarification” of competencies and responsibilities through the whole spectrum of professional groups which are involved in psychosocial support. One center for advice and information (one stop shop), clear leadership and listening to each others in interprofessional integrated groups would be essential to this process.

The second part relates to “preparedness” for emergencies. It means to be enough and appropriate educated, trained and to have plans. The planning should go from the national to the local level and it should be consulted with experienced professionals in the mental health field. Further, experts on mental health should always act considering the ethical aspects of the delivered care and focus on personal needs of the survivors, respect individual differences and act always with an explicit human attitude to the affected people.

The third area is “financing”. It seems that the financing of involved professionals and budget for whole system of psychosocial support is essential and this is an important task for politicians in the future.

Finally, a very important issue is the tight collaboration between professionals, lay experts of victim organizations as well as politicians and policy makers. All of them should be brought together, collaborate and make integrated decisions over the acute, mid and long term psychosocial aftercare. This is particularly important in the organization of morning rituals, financial support for mid and long term support programs and the relation with the media.

Ariëlle de Ruijter Impact Dutch Knowledge and Advice Centre for Post Disaster Psycho Social Care 25-06-08