Welcome Feedback on Evaluation Questions Housekeeping

ROLES OF SERVICE PROVIDERS

 Please identify the types of work you do with survivors.

WHAT IS YOUR GOAL?

Active Screening:
What is Your Role? What is Your Goal? Used by health care providers to assess and treat clients for histories of GBV.

Crisis Debriefing:
What is Your Role? What is Your Goal? Used by trauma specialists to reduce the immediate impact of a traumatic experience on the survivor.

Case Management:
What is Your Role? What is Your Goal? Used by social service providers to meet the practical needs of survivors through assessment, education, referral, and follow-up.

Counseling:
What is Your Role? What is Your Goal? Used by psychologists and other social service providers to try and address the shorthand long term. emotional and psychological needs of the survivor in order to assist the client to improve their quality of life.
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Reminder
It is not unusual to feel that a service provider must be all things at all times to a survivor. This perspective can lead to the service provider feeling overwhelmed and suffering burnout. It is therefore important for the service provider to understand their role and understand the objectives and boundaries of their work.

GATHER Model

 This model was adapted for this workshop from a reproductive health model for HIV counseling. The adapted model provides a conceptual framework for some of the important goals of working with survivors. The model can be adjusted according to the specific objectives of the service provider.

 Important aspects of this model to emphasize are: Structure: using a semistructured interview is a useful strategy for assessment because it is an organized way to collect information, and also helps to decrease the possibility of the survivor becoming emotionally overwhelmed by keeping the focus of the interview goal oriented.

 Validation and Education: At every opportunity, the service provider should offer validation to the survivor. The service provider should share knowledge and resources, rather than opinions, when providing the survivor with information.

 Referral: The service provider should always seek to link the survivor to other services. Creating a good referral network prevents the service provider from feeling like he/she must meet all the survivors needs, and helps the survivor to integrate or reintegrate into his/her community.

GATHER
Greet:
establish rapport clarify goals of meeting explain confidentiality

GATHER
Ask: ask client for a brief explanation of how you may assist her, i.e., why she is seeking assistance. Ask specific questions about exposure to violence

GATHER
Tell: If survivor acknowledges experiences of violence, offer validation and support. Reassure her that you will try to assist her.

GATHER
Help: Once basic rapport has been established and you have identified the basic concerns of the survivor, it is important to conduct a more thorough assessment so that you better understand her experience of GBV and identify her related needs.

GATHER
Educate: Reflect back to survivor what you have understood are her needs and what you have heard as possible stress reactions. Provide information to survivor that will help normalize her reactions.

GATHER
Refer, Return, Review: Be prepared with list of referrals that may assist survivor. Schedule follow-up if possible. Review plan with survivor. always seek to link the survivor to other services.

Interaction Techniques
Interaction techniques are ways to communicate to a survivor that you are actively listening and to encourage survivors to share information about their experience so that you may make a more informed assessment.

 What are the techniques that promote positive communication?. any additional suggestion? What are the techniques that might inhibit communication with the survivor.? identify why these techniques are less desirable ? and what types of reactions they might elicit in the survivor?
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BREAK

Role Play
Handout: 1) Stem Statements 2) Helper Skills Evaluation Checklist We need to ask two participants to come to the front of the room. Drawing from your own experience, quickly design a scenario in which one participant is the survivor and one participant is the service provider. role play for 15 minutes in front of the entire group, using techniques outlined in the GATHER model. Ask observers to refer to their Helper Skills Evaluation Checklist when reflecting on the quality of interaction between service provider and survivor.

SPECIAL POPULATIONS

Brainstorming Exercise
divide into 6 groups of 4 or 5 people, and each group choose a population from list below: Sexual assault victims Domestic violence victims Children and adolescent victims Family members and friends of victims Elderly victims Survivors who are culturally different from service providers

 Please discuss and record what you think the special needs and engagement issues in working with these populations may be and how a service provider might respond differently to those needs. Each group will be given 5 minutes to present on their groups discussion.

Special Populations Are:

1) Sexual assault victims 2) Domestic violence victims 3) Children and adolescent victims 4) Family members and friends of victims 5) Elderly victims 6) Survivors who are culturally different from service providers

Special Populations: Important Engagement Issues

Sexual assault victims

Confidentiality Physical safety Physical boundaries (extreme sensitivity on part of service provider to impact of touch) Police reporting Medical needs Relational and/or sexual issues Stigmatization Symptom management including dealing with flashbacks

 Use the Power and Control Handout and the Cycle of Violence to supplement participants responses. Emphasize that violence can be emotional, physical, psychological, and that it is based on abusive use of power and control. Also emphasize that Western theories of domestic violence suggest that it typically happens in a cycle, getting worse over time, and that this may be important for helpers to understand in order to predict danger and helpseeking behavior of survivors of domestic violence. It may be helpful to briefly discuss with participants whether the cycle of violence theory applies to their cultural context.

Domestic violence victims

Confidentiality Safety planning Safety of children legal issues police reporting Power and Control and Cycle of Violence Future goals (remain in violent situation?) Isolation Symptom management

 violence can be emotional, physical, psychological, and that it is based on abusive use of power and control. Western theories of domestic violence suggest that it typically happens in a cycle, getting worse over time, and that this may be important for helpers to understand in order to predict danger and help seeking behavior of survivors of domestic violence. Do you think That that the cycle of violence theory applies to our cultural context.

Children and adolescent victims

Assessment of potential abuse or exposure to violence Dealing with parents Confidentiality and the law Typical child behaviors Behavior management according to stages of growth

Family members and friends of victims

Dealing with and/or anticipating trauma responses Relational issues, including supportive listening

Elderly victims
Stigmatization and ageism Isolation Physical vulnerability Live in past and different worlds Seasons of losses Regression Sense of the new and need for the old Change

Culturally different Communication (use of translator, etc.) Identification and acceptance of difference Trust Assessment of the accessibility of services

Some Coping Strategies for Elders

A. Rebuild and reaffirm attachments and relationships. Relationships are the connection to life. Let the elderly identify with whom they want to be attached. Do not assume family relationships are friendly. Nurturing and physical closeness is needed.

 B. Ask for their concerns about safety. The elderly need to know they have options in making a choice about their safety. Evacuation is highly a controversial issue in disaster. T he elderly may be more unsafe in evacuations than if they stay at the center of the disaster.

 C. It is important to talk to elders about tragedy. However, remember that their ventilation may be about their life and not about the immediate event. Do not prevent ventilation; validating past concerns is an important part of establishing trust in preparation for dealing with current concerns. The elderly may wish to talk but they may also respond well to music and opportunities to paint or create art that communicates their reactions.

 D. Caregivers should understand communication lapses in which the elderly go back and forth from the past to the present. Caregivers may be confused by an elders discussion of past events or past relationships in terms of present realities. Remember the discussion may be entirely rational and logical from the perspective to the elder.

 E.If an elderly person forgets a name, a place, or a portion of an event, the caregiver should take great precautions to avoid placing pressure on the elderly person to remember. In most cases, the elder will remember but pressure inhibits memory. F. The elderly want to have factual information but may be able to absorb the facts in limited quantity and hence ask to have the information repeated a number of times. Eventually they will have integrated it and information will give them better control over the event itself.

 The elderly should be given short-term predictions on what will happen to them immediately after the disaster. Specific times and places for events should be made clear. It will help to delineate events on a calendar or a clock so that they can more easily track the future. Caregivers should spend time addressing basic needs in a detailed way: who will feed the older person; where will s/he stay at night; where will the person be able to get clothes; what property may be rescued; and so forth.

 Finally: In addition to the special populations we have just mentioned, it is likely that you will come into contact with difficult survivors who will require additional attention and care. These include the suicidal/homicidal survivor, escalating survivor, drug or alcohol abusing survivor and mentally disturbed survivors. You may also come into contact with perpetrators who are angry or aggressive.

Thank you