This is a presentation shared at the NZ Psychological Societies annual conference held in Queenstown, New Zealand in August 2011. The presentation included a description of a process to facilitate groups of international humanitarian aid workers to develop effective coping strategies and enhance resilience when working in complex and challenging environments. A multicultural strategy that builds on existing and historical cultural coping mechanisms while integrating new understandings from modern western psychology. The work is based on systematic applied strategies in Haiti following the earthquake in 2010 and in Sudan and Chad as part of a major project funded by OFDA (USA) and managed by InterAction (USA) and People In Aid (UK). For further information contact the author. John Fawcett. Email jfawcett@orcon.net.nz

1. Organisational & Cultural Factors that Promote Coping.With Reference toHaiti and Christchurch John Fawcett, MA August, 2011 © John Fawcett “Building Resilience in Complex Environments”

2. Brief HistoryFocus on design and implementation of organisational practices that support resilience and coping Experience Cambodia 1993 - 1997 Global Director of Staff Support programs for World Vision International and Save the Children USA Global Research study with School of Psychology at Fuller Seminary, CA, 2000 Middle East and Europe study 2003 Longitudinal Study CDC & Antares Foundation 2003 – present (ongoing) Asian Tsunami, Afghanistan, Haiti, Sudan, Chad, Christchurch © John Fawcett “Building Resilience in Complex Environments”

3. Population of Interest Employees of agencies and organisations specifically in responding to or providing services in the disaster/emergency context Wider social networks of employees including family, friends, colleagues onsite or globally dispersed Covers those directly (‘because’ of it) or indirectly (caught up in it) involved © John Fawcett “Building Resilience in Complex Environments”

4. The three key points People employed in Disaster Response activities form a discrete population at specific risk of experiencing disabling Psychological conditions Organisational processes; increase risk to health and, protect staff from disabling Psychological conditions Cultural values, practices and structures play key roles in creating successful organisational processes that mitigate Psychological Distress © John Fawcett “Building Resilience in Complex Environments”

5. And the important sub-point External experts (including Clinical Psychologists) are not very successful in enhancing organisational processes to protect staff and build resilience. Internal staffing positions at high management levels dedicated to enhancing protective processes have the highest ROI and success in improving staff resilience and coping. © John Fawcett “Building Resilience in Complex Environments”

6. The key ‘fascinating’ findings No significant differences for clinical measures across location, role, type of environment, age, gender Risk prevalence for Trauma and associated conditions ranged from 10 – 50% (lower = European, higher = non-European) Prevalence of actual clinical conditions are significantly less than comparative ‘general’ populations Across all demographics Social Support is positively linked to lower risk and clinical conditions Flipping the figures shows majority of employees are generally coping reasonably well. The evidence shows that Organisational factors comprise over 60% of stressors Cultural realities raise serious questions about the reliability and validity of much Psychological Trauma data as it relates to non-European populations. © John Fawcett “Building Resilience in Complex Environments”

7. My work over the past 20 years… Identifying the nature of ‘distress’ experienced by disaster response personnel Identifying protective factors that keep personnel from experiencing disabling psychological consequences Creating organisational strategies/structures/processes/frameworks that address consequences of disabling exposure and enhance coping/resilience © John Fawcett “Building Resilience in Complex Environments”

8. Underpinned by Social Support Subjects with compromised social support are: 4 times as likely to be experiencing traumatisation 3 times as likely to be experiencing some form of unwellness 2.4 times as likely to be experiencing some form of acute anxiety; 2.5 times as likely to be experiencing some kind of physical illness Ref: Fawcett, J, “Stress and Trauma Handbook” (2003), World Vision Publications pp118-119 © John Fawcett “Building Resilience in Complex Environments”

9. If Social Support is Protective then.. Then there is a high potential ROI where organisations build social support processes into operational practices. This does not exclude ‘treatment’ options for those who are impacted by events, environment or organisational factors © John Fawcett “Building Resilience in Complex Environments”

10. Practice Model built on two primary principles Principle 1 Most people employed in Disaster Response activities do not experience disabling levels of clinical Psychological conditions. (2 – 13% PTSD) Rather, most experience high but normal (and unsurprising) response to complex, distressing events and environments (15 – 25% Depression, anxiety) ref: www.headington-institute.org © John Fawcett “Building Resilience in Complex Environments”

11. Practice Model built on two primary principles (cont) Principle 2 All cultures have sophisticated mechanisms that; Enhance resilience Build coping ability Transmit hardiness Promote hope © John Fawcett “Building Resilience in Complex Environments”

12. Principles to Practice Invite the local ‘culture’ to; Define “distress/pain/suffering” Identify existing factors that cause this ‘pain’ Identify existing/past/present mechanisms that ‘manage’, ‘mitigate’, ‘heal’ this pain Identify gaps between the present types and levels of ‘distress’ and existing (and presently accessible) mechanisms (resources, processes) that mitigate pain and enhance healing © John Fawcett “Building Resilience in Complex Environments”

13. So what did we do? In Haiti……… © John Fawcett “Building Resilience in Complex Environments”

14. HaitiTi kozebyenèt“A little chat about Wellness” © John Fawcett “Building Resilience in Complex Environments”

15. In Christchurch © John Fawcett “Building Resilience in Complex Environments”

16. Extremely flexible working conditions EAP Counsellors to each site office Wide brief for interventions Employees encouraged to ‘do what is needed’ Leader/managers provided direct support All employee social networks covered by EAP brief – anywhere in the city All incoming/outgoing employees covered Shared space/resources © John Fawcett “Building Resilience in Complex Environments”

17. How Culture impacts Organisational Protective Practices All organisations have distinct cultures Organisations exist within broader local cultures Organisational culture varies by location Despite Western business models there is no ‘real’ distance between internal organisational culture and external social, family, kinship cultures Only cultures that have strong values of compassion will succeed in protecting employees and family members © John Fawcett “Building Resilience in Complex Environments”

18. Building Resilience in Organisations Western Organisational culture is generally resistant to incorporating the value of ‘compassion’ into operational practice Where the value underpinning staff support programmes is “OSH” rather than “compassion” these process can be experienced as an enforcement rather than care External consultants/experts hardly ever change organisational culture Changing organisational culture from the inside is lifetimes work © John Fawcett “Building Resilience in Complex Environments”

19. Who has the highest resilience? Haitians or Cantabrians? © John Fawcett “Building Resilience in Complex Environments”

20. References Eriksson, C., Larson, L, Fawcett, J. & Foy, D (2005, June). Social and Organizational, Support, Depression, and PTSD in International Humanitarian Aid Workers. Paper presented at the 9th meeting of the European Conference on Traumatic Stress, Stockholm, Sweden Cardozo, B. L., & Salama, P. (2002). Mental health of humanitarian aid workers in complex emergencies. In Y. Danieli (Ed.), Sharing the front line and the back hills: Peacekeepers, humanitarian aid workers and the media in the midst of crisis. Amityville, NY: Baywood Eriksson, C. B., Bjorck, J. P., Larson, L. C., Walling, S. M., Trice, G. A., Fawcett, J., et al. (2009). Social support, organisational support, and religious support in relation to burnout in expatriate humanitarian aid workers. [Article]. Mental Health, Religion & Culture, 12(7), 671-­686. doi: 10.1080/13674670903029146 Fawcett, J. (2003) Stress and Trauma Handbook. World Vision International Ehrenreich, J. (2005) The Humanitarian Companion: A Guide for International Aid, Development and Human Rights Workers. Practical Action © John Fawcett “Building Resilience in Complex Environments”