Comprehensive Notes on Psychosocial Health Support Services

Unit Description: Psychosocial Health Support

• The unit standard specifies the competencies required to provide psychosocial health support in the health industry.

• Key competencies include:

  • Identifying and assessing patients for psychosocial healthcare needs.

  • Caring for patients with psychosocial health needs.

  • Linking patients to appropriate psychosocial healthcare.

  • Following up on psychosocial healthcare support.

  • Documenting psychosocial health support services.

• Performance is assessed against World Health Organization (WHO) standards and Psychosocial Healthcare Standards.

• The assessment process involves:

  • Identifying patients who require support.

  • Creating rapport between the healthcare giver and the patient.

  • Analyzing the nature and extent of the psychosocial need using assessment reports.

• Care implementation involves:

  • Prioritizing needs based on assessment analysis.

  • Providing specific psychosocial healthcare.

  • Identifying and gathering requirements for support services.

  • Facilitating collaborative care between psychosocial and biomedical interventions.

• Monitoring and Follow-up:

  • Patients must be monitored in accordance with WHO and internal standards.

  • Routine care must be conducted and conditions reported to relevant personnel.

  • Faults in care delivery must be reported and rectified per workplace policy.

• Documentation and Dissemination:

  • Patient details and progress reports must be documented.

  • Reports are disseminated to relevant authorities.

  • Waste must be disposed of in accordance with environmental protection regulations.

Basic Concepts of Psychosocial Support

• Impact of Disasters:

  • Disasters can result in the loss of loved ones or property.

  • Emotional effects can manifest immediately or appear later.

  • Outcomes tend to be more negative as the severity of the disaster increases (measured by perceived threat to life, exposure to destruction, or hearing distressing things).

  • Both survivors and relief personnel experience stress and are at risk for burnout.

• Defining Psychosocial:

  • Psychosocial refers to the close connection between psychological aspects of human experience and the wider social experience.

  • Psychological Effects: These affect functions across three levels:

    • Cognitive: Perception and memory forming the basis of thoughts and learning.

    • Affective: Emotional states.

    • Behavioral: Outward actions.

  • Social Effects: These involve relationships, family and community networks, cultural traditions, economic status, and life tasks like school or work.

• The Totality of Experience:

  • Psychosocial wellbeing is based on the integration of biological, emotional, spiritual, cultural, social, mental, and material factors.

  • It focuses on the interpersonal contexts of family and community networks rather than just physical or psychological health in isolation.

• Support Scale:

  • Support ranges from care provided by families, neighbors, and health workers to specialized psychological and social services.

  • It aims to maintain a continuum of care during and after humanitarian crises to prevent long-term mental health disorders.

Vulnerable Groups and the Intervention Pyramid

• Vulnerable Groups for Psychological Consequences:

  • Elderly persons.

  • Children and adolescents.

  • Women (especially pregnant or lactating).

  • Single-parent families.

  • Extremely poor people.

  • People with disabilities or chronic health conditions.

  • The bereaved.

  • Rescue and relief workers.

• Layered System of PSS (Psychosocial Support) Implementation:

  • Level 1 (Base): Basic Services and Security. Protecting wellbeing by meeting rights for security, food, water, healthcare, and shelter. CHWs advocate for these to be delivered respectfully.

  • Level 2: Community and Family Supports. Focuses on social support networks and family reunification (family tracing).

  • Level 3: Focused Supports. Individual, family, or group interventions for specific issues like gender-based violence (e.g., support groups for victims of rape), carried out by trained workers.

  • Level 4 (Top): Specialized Services. Psychological or psychiatric supports for individuals with mental disorders that cannot be managed within primary health services, affecting basic daily functioning.

Foundations of Psychology

• Etymology:

  • Derived from Greek: "psyche" (spirit or soul) and "logos" (discourse or study).

• Definition:

  • Psychology is the scientific study of behavior and mental processes and how they are affected by physical state, mental state, and environment.

  • Behavior: All outward or overt actions and reactions (talking, facial expressions, movement).

  • Mental Processes: Internal, covert activities (thinking, feeling, remembering).

• Classification of Psychology:

  • Basic Psychology: Concerned with theory formulation and research support (e.g., developmental, cognitive).

  • Applied Psychology: Application of theories to change human behavior (e.g., clinical, counseling, educational, forensic).

• Fields of Psychology:

  • Abnormal Psychology: Describes and controls unusual/non-normative behaviors and psychological disorders.

  • Cognitive Psychology: Deals with how individuals acquire, store, transform, and apply information.

  • Clinical and Counseling Psychology: Focuses on diagnosis and treatment of psychological disorders.

  • Educational Psychology: Studies human learning and how variables influence outcomes in classroom settings.

  • Environmental Psychology: Studies the interaction between physical environments (noise, heat, pollution) and human behavior.

  • Health Psychology: Focuses on the impact of psychological factors like stress on illness and lifestyle disease management.

  • Organizational Psychology: Applies principles to workplace selection, leadership, and job satisfaction.

  • Developmental Psychology: Studies physical and psychological changes across the lifespan.

  • Forensic Psychology: Applies psychology to the legal system.

Personality Theories and Development

• Core Definitions:

  • Personality: Distinctive patterns of behavior, mannerisms, thoughts, and emotions characterizing an individual over time.

  • Traits: Habitual ways of behaving, thinking, and feeling (e.g., confident, pessimistic).

  • Character: Characteristics evaluated by others.

  • Temperament: Hereditary aspects including sensitivity, moods, and irritability.

• Sigmund Freud: Psychoanalytic Theory:

  • Personality Structure:

    • Id: Totally unconscious; operates on the Pleasure Principle (immediate satisfaction of biological urges).

    • Ego: Executive/mediator; operates on the Reality Principle (delays action until appropriate); partially conscious.

    • Superego: Judge/censor; operates on the Morality Principle. Includes the Conscience (punished actions) and Ego Ideal (approved behavior).

• Freud's Defense Mechanisms (to protect the Ego):

  • Regression: Seeking security of an earlier developmental period.

  • Repression: Forcing painful thoughts into the unconscious.

  • Displacement: Shifting feelings to a safer target.

  • Sublimation: Replacing unacceptable impulses with socially acceptable ones.

  • Reaction Formation: Transforming a feeling into its exact opposite.

  • Projection: Attributing personal faults to others.

  • Rationalization: Giving false but acceptable reasons for behavior.

  • Denial: Refusing to accept reality.

  • Identification: Unconscious modeling of oneself after another.

  • Introjection: Integrating another's values into the ego structure.

• Freud's Psychosexual Stages:

  • Oral (0–1.5 years): Focus on mouth; fixations lead to oral-dependent or oral-aggressive personalities.

  • Anal (1.5–3 years): focus on elimination; fixations lead to Anal Retentive (orderly) or Anal Expulsive (messy) traits.

  • Phallic (3–6 years): Focus on genitals; Oedipus Conflict (boys) and Electra Conflict (girls).

  • Latency (6–Puberty): Dormant psychosexual development.

  • Genital (Puberty onward): Realization of adult sexuality.

• Erik Erikson: Psychosocial Theory (8 Stages):

  1. Trust vs Mistrust (0–1.5 years): Learning to trust through care.

  2. Autonomy vs Shame/Doubt (1.5–3 years): Discovering skills and independence.

  3. Initiative vs Guilt (3–5 years): Exploratory/investigative attitude.

  4. Industry vs Inferiority (5–13 years): Enjoyment of mastery and success.

  5. Identity vs Role Confusion (13–21 years): Questioning "Who am I?".

  6. Intimacy vs Isolation (21–39 years): Preparing for/exploring relationships.

  7. Generativity vs Stagnation (40–65 years): Productivity and guiding the next generation.

  8. Integrity vs Despair (65+ years): Reflecting on life satisfaction.

Cognitive and Learning Theories

• Jean Piaget: Cognitive Development:

  • Processes:

    • Assimilation: Using existing knowledge for new situations.

    • Accommodation: Changing knowledge for new situations.

    • Equilibration: Restoring balance through mastering challenges.

  • Four Stages:

    1. Sensorimotor (0–2 years): Exploring via senses; development of object permanence.

    2. Preoperational (2–7 years): Better speech; egocentric; inability to understand conservation of matter.

    3. Concrete Operational (7–11 years): Logical thinking about concrete events; understanding conservation; inductive logic.

    4. Formal Operations (12–15 years): Abstract reasoning/hypothetical problems; moral and ethical thinking.

• Abraham Maslow: Humanistic Theory:

  • Hierarchy of Needs:

    1. Physiological (Air, food, water).

    2. Safety and Security.

    3. Love and Belonging.

    4. Esteem and Self-esteem.

    5. Self-actualization (Fullest realization of potential).

• Learning Theories:

  • Classical Conditioning (Pavlov): Association of stimuli. Components: Unconditioned Stimulus (UCS), Unconditioned Response (UCR), Conditioned Stimulus (CS), and Conditioned Response (CR).

  • Variables: Extinction (CS no longer elicits CR), Spontaneous Recovery, Stimulus Generalization, and Stimulus Discrimination.

  • Operant Conditioning: Learning from consequences.

    • Positive Reinforcement: Adding pleasant consequences to increase behavior.

    • Negative Reinforcement: Removing unpleasant consequences to increase behavior.

    • Thorndike's Law of Effect: Behavior followed by pleasant outcomes is repeated.

    • Punishment (Positive/Negative): Decreases frequency of behavior.

Growth and Development Parameters

• Definitions:

  • Growth: Quantitative change in size/weight (measurable in $cm$ or $kg$).

  • Development: Qualitative change in function/skills.

  • Maturation: Increase in competence and adaptability.

• Principles of G&D:

  • Continuous process with a predictable sequence.

  • Cephalo-caudal (head to toe) and Proximodistal (center to periphery).

  • Occurs from general to specific.

• Assessment Formulas and Metrics:

  • Weight Formulas for Children:

    • 3–12 months: $\frac{\text{Age (months)} + 9}{2}$

    • 1–6 years: $(\text{Age (years)} \times 2) + 8$

    • 7–12 years: $(\text{Age (years)} \times 7 - 5) / 2$ (Note: page 104 lists $Age \times 7-5$ for 7-12 years).

  • Weight Milestones: Doubles by 4 months, triples by 12 months, quadruples by 2 years.

  • Height Formula (>2 years): $(\text{Age (years)} \times 6) + 77$

  • Height Milestones: $50\,cm$ (birth), $75\,cm$ (1 year), $90\,cm$ (2-3 years), $100\,cm$ (4 years).

  • Head Circumference: Birth ($35\,cm$), 1 year ($47\,cm$), 2 years ($49\,cm$).

• Developmental Milestones (Age and Task):

  • 4 months: Rolls over.

  • 6 months: Sits with support.

  • 8 months: Sits without support.

  • 12 months: Stands alone; 1-2 words with meaning.

  • 18 months: Runs; 8-10 word vocabulary.

  • 2 years: Walks up/down stairs; 2-3 word sentences.

  • Red Flags: No sitting by 9 months; not walking by 18 months; no vocalization by 6 months.

Counseling: Principles and Practice

• Definition: Face-to-face communication where one person helps another solve a problem or make an informed decision by understanding facts and emotions.

• Types of Counseling: Supportive, educational, career, crisis, grief, post-traumatic, family, and marriage.

• Counseling vs. Interpersonal Communication:

  • Interpersonal Communication: Informing, educating, and motivating individuals/groups.

  • Counseling: Specifically helping a client make a voluntary informed choice using a two-way process.

• Steps of Effective Counseling (GATHER / Effective Steps):

  • GREET the client (establish rapport).

  • ASK the client (gather information on lifestyle as well as medical history).

  • TELL (provide logically organized, specific information).

  • HELP (facilitate decision-making and problem-solving).

  • EXPLAIN (provide education materials based on the choice made).

  • RETURN/REFER (plan follow-up or refer if necessary Center).

• Qualities of an Effective Counselor:

  • Active listening, self-awareness, maturity, stability.

  • Empathy (putting oneself in the client's place) and Unconditional Positive Regard.

  • Non-judgmental approach and confidentiality.

  • Professional appearance and strong work ethic (arriving on time).

Group and Peer Counseling

• Group Counseling:

  • Homogeneous groups (6–8 to 20 members).

  • Types: Task groups, Guidance/Psychoeducational groups, Interpersonal Problem-Solving groups, Psychotherapy groups, Support groups, Self-help groups (e.g., AA).

  • Stages of Group Development:

    1. Orientation/Forming: Becoming oriented.

    2. Transition/Storming: Conflict and anxiety as members struggle to define themselves.

    3. Cohesiveness/Norming: Therapeutic alliance and trust form.

    4. Working/Performing: Experimenting with new behaviors.

    5. Adjourning/Terminating: Disbanding.

• Peer Counseling:

  • Support provided by trained peers who share a common identity (age, career, gender).

  • Is brief, less formal, and non-disciplinary.

  • Keat's "HELPING" label for Peer Counseling:

    • H: Help

    • E: Empathy

    • L: Learning

    • P: Peers, people, problems

    • I: Interests/Self-image

    • N: Needs

    • G: Giving guidance

HIV/AIDS Counseling

• Core Principle: Treat HIV as a chronic condition rather than a terminal disease; avoid stigma.

• Key Tasks:

  • Correct myths and misinformation.

  • Provide power of informed choice.

• Pre-test Counseling:

  • Prepare the client for the result and explain window periods (need for re-testing).

  • Obtain informed consent.

  • Discussion of sexuality and risk behavior.

  • The "BRAIDED" approach for counseling units: Benefits, Risks, Alternatives, Inquiries, Decision to withdraw, Explanation, Documentation.

• Post-test Counseling:

  • Results should always be given with counseling.

  • Positive result: Clear and gentle disclosure, providing emotional support and referral services.

  • Negative result: Highlight the "window period" (3–6 months) and reinforce prevention techniques.

• Attitudes of PLWHA (Persons Living With HIV/AIDS):

  • Fear (of dying or isolation).

  • Guilt and shame regarding transmission.

  • Anger (directed at self, others, or God).

  • Denial and Depression (hopelessness, suicide risk).

Professional Ethics in Counseling

• Elements of Ethics:

  • Non-Discrimination: No bias against any group.

  • Client Welfare and Relationship: Putting client needs first.

  • Trustworthiness and Duty of Care.

  • Confidentiality: Maintaining privacy from third parties.

  • Dual Relationships: Avoiding conflicts of interest by not interacting with clients outside of professional settings.

  • Preventing Harm and Misrepresentation.

• Essential Counselor "Don'ts":

  • Don't ask "why" or use leading questions.

  • Don't use "shoulds" and "oughts".

  • Don't blame, criticize, or embarrass the client.

  • Don't automatically compare client experiences with your own.

  • Don't reduce counseling to giving advice.

  • Don't breach confidence or misrepresent capabilities.

• Limitations of Counseling:

  • Does not guarantee the counselee will not make future mistakes.

  • Risk of the counselee becoming over-dependent on the counselor.

  • Counselee may not gain the liability of self-analysis in directive counseling.