Psychosocial First Aid with Vulnerable Groups

What is Vulnerability?

Characteristics and circumstances of a person or a group of people influence their ability to anticipate, cope, respond and recover from the impact of crisis events or disasters. When there is a threat of disaster, the vulnerable sections such as pregnant women, orphan children, persons with disability and uncared aged of the population need special attention. There is a wide range of biological (sex, health conditions, disability), social (poverty, gender, age, education), and environmental (place of stay) factors that make a person vulnerable. Factors that determine vulnerability might vary based on the disaster. For instance:

• Some of the vulnerable groups identified during the first wave of the COVID-19 pandemic were the elderly, persons with specific health conditions, and migrants.
• During cyclones or storms, people living in coastal areas/fisherfolk can be vulnerable.
• In gas leaks, people residing in or around the gas/ nuclear plant.
• During droughts and insect infestations, farmers need special care and attention.

Though vulnerable groups keep changing, vulnerability based on age (children, elderly, etc.), gender (women, LGBTQIA+ etc.), socio-economic status (lower income status, homeless, etc.,), ethnicity (religious minorities, indigenous group etc.), displaced population (migrants, refugees, etc.) and health conditions (persons with severe medical and psychological illness) remains the same. Generally, children, women, the elderly, and persons with disabilities are sections of population who might require special assistance during emergencies. This chapter would orient the readers on how the needs of vulnerable groups can be addressed using PSFA. Understanding the factors influencing the vulnerability of a group of people or community and their needs during an emergency is important to plan and implement psychosocial care.

 Vulnerable groups, require special attention during different types of disasters

Why do care providers need to focus on the vulnerable groups?

These people are the ones who are away from mainstream society. Most often because of various psychosocial factors, they are prone to;

PSFA helps these population to feel safe, access essential resources, feel listened to, and ensure opportunities to enhance support. It also empowers people in need for special attention to extend support and minimize the negative consequences of a disaster.

PSFA for vulnerable groups

PREPARE

• Understand vulnerable populations specific to a disaster.
• Understand the biopsychosocial factors that make people vulnerable.
• Locate vulnerable groups in the disaster area.
• Identify resources within the community

LOOK

• Immediate emotional reactions (anxiety, confusion, anger).
• Physical health issues.
• Psychosocial needs and concerns.
• Availability of support within the family.
• Availability of local/community resources.
• Strengths of the vulnerable person and their family/ community

LISTEN

• Listen to their views on the situation and their concerns.
• Acknowledge their strengths.
• Normalize thoughts their feelings and thoughts.
• Give reassurance.
• Ensure their safety.
• Provide basic needs.

LINK

• Always keep them with their primary caregivers or loved ones.
• Link with a protection agency or other support (unaccompanied child with the child protection agency, an older adult having no caretaker to the old age homes).
• Connect them to a safe place for shelter and fulfill their basic needs.
• Connect them to medical care facilities based on their physical and psychological concerns (persons with mental illness to respective district mental health programs; and hearing aid for persons with hearing impairment).

Tips for effective listening

• Listen attentively without any interruptions.
• Understand their pain and distress.
• Empathize by placing yourself in their difficult positions.
• Make them feel understood by leaning forward and using head nods.
• Look into their eyes while interacting.
• Make them feel comfortable (provide water, food or talk politely).
• Give a pat on their shoulder, touch or hold their hands (ensure they are of your gender and are comfortable).
• Allow and respect their silence.
• Do not ask them to stop crying.
• Do not pressurize them to talk.

Case scenarios indicating the need for PSFA

• Case 1: During COVID-19, a five-year-old boy was tested positive. He was asked to be in a quarantine center for 15 days. He was scared and not willing to stay away from the family. The family was not ready to leave the child.
• Case 2: During a landslide, a 14-year-old girl lost her father, mother, and her house. She has two younger brothers. She was grieving and feeling lost, thinking of herself and her sibling’s future.
• Case 3: During a flood, a 45-year-old unmarried lady was left alone and was waiting for the rescue team in her flood-affected house. A resident brutally raped her. By the time the rescue team came, she was lying unconscious on the floor.
• Case 4: During Tsunami, a 30-year-old person with a locomotor disability was severely injured and lost his wheelchair. Since he was from a poor socio-economic background, his family could not arrange for a new wheelchair.
• Case 5: During an earthquake, a 37-year-old woman with chronic mental illness was rescued by the disaster team. She was left alone as her mother, the primary caretaker, was severely injured and critical.
• Case 6: During a building collapse, a 69-year-old lady was rescued by the rescue team. She was crying and was in shock as she could not find her son and family. She had no one to depend on since she was new to the place and found it difficult to ask for help from others at the camp.

PSFA strategies to help the vulnerable group of people

PSFA strategies to help Children

Look

• Emotional reactions ( irritability, sadness).
• Physical reactions (aches pains, sleep difficulties, injuries).
• Cognitive issues (difficulty to concentrate, worthlessness).
• Needs and concerns ( education, safety).
• Whether the child is unaccompanied.
• Whether the child is unattended.
• Whether the child is in a disturbing environment (gruesome scenes, injured people, unpleasant exposures).
• Forced to play adult roles because of situational pressure due to death of parents, mobility issues in primary caregivers.
• Presence of emotional and behavioural disturbances.
• Risk of physical or sexual exploitation.
• Strengths and resources.

Listen

• Views on the situation and concerns.
• Fear and worries.
• Upsetting thoughts and memories.
• Experiences and distress.
• Relate to them at their level and stay calm in the process.
• Help the young children to verbalize their feelings, perceptions and concerns through play activities (sentence completion, doll play, storytelling, etc.).

Link

• Primary care givers or loved ones.
• Unaccompanied child to child protection network.
• Children with acute health conditions to health care facility.
• Children with mental health concerns to mental health professionals/ DMHP.
• NGO/GOs catering to the needs of the children in crisis.

PSFA strategies to help Women

Look

• Emotional reactions ( irritability, sadness)
• Physical reactions (aches pains, sleep difficulties, injuries, menstrual/reproductive difficulties)
• Cognitive issues (difficulty to concentrate, worthlessness, negative thoughts)
• Needs and concerns
• Domestic violence
• Homelessness
• Reproductive health issues
• Privacy concerns
• Role burden/role multiplicity
• Financial instability
• Presence of mental and physical health conditions
• Risk of physical or sexual exploitation
• Strengths and resources (support system)

Listen

• Views on the situation and concerns
• Fear and worries
• Upsetting thoughts and memories
• Experiences and distress
• Listen with empathy and compassion, and acknowledge their feelings
• Culture specific demand to play their role as a woman

Look

• Basic needs
• Women’s organizations to protect their rights
• Women with acute health conditions to the health care facility
• Women with mental health concerns to the mental health professionals
• NGO/GOs catering to the needs of the women in crisis

PSFA strategies to help elderly

Look

• Emotional reactions ( irritability, sadness, guilt).
• Physical reactions (aches pains, sleep difficulties, injuries, comorbid health conditions).
• Cognitive issues (difficulty to concentrate, forgetfulness,
• worthlessness).
• Needs and concerns (mobility, functionality, dependance).
• Financial burden/stability.
• Presence of mental and physical health condition.
• Strengths and resources (support system).
• Elderly abuse/ neglect.

Listen

• Views on the situation and concerns.
• Fear and worries.
• Upsetting thoughts and memories.
• Experiences and distress.
• Listen with empathy and acknowledge their feelings.
• Treat them with respect and dignity.

Link

• Basic needs.
• Connect them to the primary care takers or loved ones.
• Institutions/individuals supplying the necessary aids.
• Organizations working for the elderly.
• Health care facilities in case of acute health concerns.
• Mental health professionals in case of psychological concerns.
• Governmental policies and schemes.

PSFA strategies to help persons with disability

Look

• Emotional reactions ( irritability, sadness).
• Physical reactions (aches pains, sleep difficulties, injuries).
• Cognitive issues (difficulty to concentrate, worthlessness, negative thoughts).
• Needs and concerns (mobility, dependance).
• Financial burden/ stability.
• Presence of mental and physical health condition.
• Risk of physical or sexual exploitation.
• Strengths and resources (support system).
• Care giver burden.
• Stigma and discrimination.
• Modalities of communication.

Listen

• Views on the situation and concerns.
• Fear and worries.
• Upsetting thoughts and memories.
• Experiences and distress.
• Listen with empathy and acknowledge their feelings.
• Treat them with respect and dignity.
• Use modalities in which the person is comfortable to communicate

Link

• Basic needs.
• Assistive devices.
• Connect them to the primary caretakers or loved ones.
• Organizations working for the persons with disability.
• Health care facilities in case of acute health concerns.
• Mental health professionals in case psychological concerns

Source : National Disaster Management Authority