Presentation of
Two Pilot Projects in Northern Italy
Spiritual Assistance in Emergency
and
Psychology of Emergency
in the Province of Bolzano/Bozen (Südtirol)
Gottfried Ugolini, priest and psychologist
Ladies and gentlemen, good morning/good afternoon!
It is a real pleasure for me to be here in this beautiful and
great country. May I greet you all also on behalf of the colleagues
who work with me on the two pilot projects which I am going to
present.
My presentation includes three sections:
1. first I am going to talk about the idea and the implementation
of the pilot project for spiritual assistance in emergency provided
by laypeople and peers;
2. secondly I am going to present the concept and service known
as “psychology of emergency”, and
3. thirdly, I am going to focus on some institutional aspects
and, in particular, the coordination of the two services by an
association which encompasses all the organisations involved in
the care for people in the form of “First aid for the soul”.
0. Some information about the Province of Bolzano/Bozen
The Province of Bolzano/Bozen, known as Südtirol (South
Tyrol) is located in Northern Italy and borders on Austria. Here
both Italian and German are spoken, both cultures are present
and partially integrated.
About 480.000 people live here in the middle of the Alps.
Politically the Province of Bolzano has autonomy to safeguard
the rights of the German speaking minority. Therefore we have
our own emergency and rescue organisation - Weisses Kreuz/Croce
Bianca (White Cross) - which is the local equivalent and partner
of the national and international Red Cross. The White Cross owns
three helicopters.
The headquarters of the professional fire brigade is located
in Bolzano, the capital city of the Province. All other smaller
towns and villages have their own corps of voluntary firefighters.
In the alpine areas of the Province alpine rescue is provided
by a dedicated department, which is also operated by volunteers.
1. Spiritual Assistance in Emergency and its development
1.1 A much needed idea
In 1996 on the occasion of an international training event, some
rescuers of the White Cross were informed about the service of
Crisis Intervention and Spiritual Assistance in Emergency for
rescuers and firefighters. They were impressed as they realized
the following:
§ as rescuers we get the best possible training;
§ our ambulances and emergency bags are best equipped;
§ our organisation and the cooperation with others, who are
also active in the event of an accident, are generally quite satisfying.
But they also realized that there was something missing, namely:
§ instructions about how to behave in dealing with uninjured
people, their families or friends are often lacking;
§ we don’t even know how to control our own reactions
and how to cope with our own emotions during and after an intervention;
§ finally, we don’t know how to help our colleagues
after traumatic interventions. We haven't received any specific
training in this field, therefore we can only rely on our own
“common sense”.
All this was now to change. With the above in mind these rescuers
addressed Arthur Punter, one of their peers with a theological
background, who was immediately persuaded of the validity of the
idea. He gathered some colleagues, including myself, to discuss
the opportunity to provide both services in our Province too.
Now the service of Spiritual Assistance in Emergency is established
and Arthur Punter is our chief leader.
1.2 The realization of the idea
What was clear from the very beginning is that our Province is
too small for two services. Therefore we combined the two, "Crisis
Intervention" and "Spiritual Assistance in Emergency",
under the name of the latter.
The aims of the service were defined as follows:
· offering assistance to uninjured people involved in
serious accidents or to family members in the event of unsuccessful
reanimation of one of their beloved;
· providing care for rescue teams in terms of defusing
and debriefing, and
· training our members as well as the members of the rescue
teams.
The White Cross supported our idea from the very beginning. The
decision was made to launch the service as a pilot project in
one of the White Cross departments and integrate it into the more
traditional activities of the rescue teams as much as possible,
in order to gather first experiences.
Already before we could start we were confronted with the first
request for a debriefing. At that time we didn’t know exactly
what debriefing is all about: we simply talked with the rescuers
about their experiences in and after an intervention following
an appalling family tragedy.
The feedback we received was very positive. Talking about their
thoughts, feelings and reactions was quite relieving for the operators
involved. Hence we were encouraged to go ahead with our pilot
project.
In 1997 we set up the first group with 7 volunteers whom we trained
in psycho-traumatology, crisis intervention and Spiritual Assistance
in Emergency.
1.3 How to get the idea implemented in a rescue organisation?
As has already been mentioned, the pilot project was implemented
at the level of the White Cross institution. Consequently every
member of the service is also a member of the White Cross rescue
association with all the rights and duties deriving therefrom.
In this way the service is also financially supported.
The service is defined as follows:
“Spiritual Assistance in Emergency is a voluntary service
offering human and religious assistance
to each individual whose personal and social life is affected
by a traumatic accident or illness leading to acute psychic distress.”
1.4 How does it work?
Our volunteers have a monthly schedule with day or night shifts.
We cannot guarantee the presence of each group on a 24 hours basis.
The service is alerted by the rescue team on site through the
countrywide emergency number 118.
The volunteers on call check the demand and begin the intervention
or refer the case to other practitioners (physicians or clergymen)
or the psycho-social services such as the psychiatric or psychology
service.
All interventions are performed by at least two volunteers who
may ask for reinforcement if necessary.
1.5 What are the indications for intervention operations?
The service is alerted whenever the demand arising is in line
with one of the following parameters:
Ø failed reanimation
Ø SID (spontaneous and immediate death of children)
Ø leisure accident, road accident, work accident, accident
involving a rescue team
Ø death notification together with the police
Ø search for missing persons
Ø suicide and suicide attempt
Ø catastrophes and disasters.
1.6 Who are the volunteers? What are their professional backgrounds?
Our volunteers have various professional backgrounds. Some of
them are psychologists. Some are (former) members of rescue teams.
The minimum age to become a volunteer is now 28.
1.7 How are the volunteers prepared and trained?
Training includes basic knowledge of psychotraumatology, crisis
intervention, spiritual assistance, communication, stress management,
salutogenesis and strategies to elicit resources and promote resilience.
Theory and practice are always integrated.
A training course in paramedical first aid and a traineeship with
a rescue team are also envisaged.
Every volunteer has to attend the monthly supervision meetings
and 8 hours of permanent vocational training per year.
Some volunteers are specialized in defusing and debriefing. Therefore,
as peers they can also provide care intervention to rescue teams.
1.8 What are the main characteristics of the service?
Spiritual Assistance in Emergency is a service offered to people
who are not or are only slightly injured after an accident or
to the family or friends of somebody deceased after failed reanimation.
It is provided immediately after an accident in one session of
a duration of 2 to 3 hours on average.
The service consists in staying with the people affected, being
there for them, listening to them and helping them to express
their own thoughts, feelings, values, spiritual orientation or
religious beliefs, offering them support and protection in their
confusion, thus enabling them to recover some stability, resume
control over the situation and attain self-empowerment.
The social network is activated and involved in the assistance.
The service is free of charge and performed by professional volunteers/peers.
1.9 How is the service internally organized?
Spiritual Assistance in Emergency is a service with a very simple
but clear organisational structure, headed by a committee. Each
group has its own leadership. The service, which has developed
its own parameters and guidelines, is structurally integrated
into the provincial rescue organisation White Cross, which guarantees
insurance coverage and offers some special benefits.
1.10 Positive achievements and unexpected results
§ Rescuers have developed more psycho-social sensitivity
and competence towards the injured and their families as well
as their own colleagues.
§ Rescue organisations and the authorities have developed
an increased awareness of their responsibility for the health
of their members especially - but not exclusively - after interventions
under traumatogenic cir*****stances.
§ The interest of the general public in getting information
and basic knowledge about crisis intervention, neighbourhood help
and social responsibility has increased.
§ Meanwhile the training programmes of the rescue organisations
include modules on basic psychotraumatology, stress management,
strategies to elicit resources and promote resilience as well
programmes to enhance the awareness of staff leaders when it comes
to assessing the need for defusing. All this in order to ascertain
the need for debriefing and in particular to pre-empt the development
of PTDS through consultation with mental health professionals.
§ In 2003 we organised a local congress: "Spiritual
Assistance in Emergency: a service for rescue organisations”
to which all rescue organisations and also psychologists were
invited.
1.11 Let us have a look at the statistics of last year
In 2005 there were over 150 volunteers organised in eight groups.
We performed 153 intervention operations and assisted 662 people,
of whom about 25 % were tourists.
The groups attended 96 monthly supervision meetings in total.
1.12 What are the prospects for the future?
Our intention is providing a 24 hours service of Spiritual Assistance
in Emergency covering the whole Province. This could become reality
by 2008.
Consequently we need an adequate number of qualified volunteers
to form new groups and a chief leader to work on a full-time basis.
Furthermore the institutionalisation of the service will be continued
to achieve full juridical and financial security.
Finally, we will promote further qualification of the service
and continue its evaluation.
2. Psychology of Emergency
2.1 The first ideas
At the end of the 90s two conferences on “Psychology of
Emergency“ took place in the Province of Bolzano/Bozen:
a national symposium and an international conference organized
by the Association of German Psychologists.
The interesting presentations and reflections on both conferences
and the concrete experiences of the Spiritual Assistance in Emergency
led to the idea of establishing a group of Psychology of Emergency
in our Province.
2.2 How did we proceed?
In 2001 the local government asked the association of psychologists
to define a project for the Psychology of Emergency.
I was a member of the drafting committee and could draw on my
experience as a volunteer in the context of the Spiritual Assistance
in Emergency.
The project was accepted by the political authorities who took
the decision to establish a service of Psychology of Emergency
in 2003.
Immediately we started the search for suitable candidates and
prepared the training programme.
2.3 What does Psychology of Emergency mean?
"The term Psychology of Emergency refers to theories, methods
and techniques for the prevention, diagnosis, counselling, intervention
and ongoing training needed to provide immediate and/or ex-post
assistance in the event of unexpected psychologically distressing/traumatic
situations in which people find themselves - either directly or
indirectly - involved, such as accidents, violence, suicides,
catastrophes or others.”
2.4 What are the objectives of the Psychology of Emergency?
The main objective of the Psychology of Emergency is reducing
psychic suffering (PTSD) through timely interventions. The psychology
of Emergency aims at providing:
n psychological support to the (direct and/or indirect) victims
of a traumatic event on site on the basis of a specific catalogue
of indications;
n the assurance of an ongoing support to the victims of a critical
accident and/or their family members, who may be referred to psychologists,
psychiatrists or other institutions;
n the care for members of rescue teams after traumatic accidents
through defusing, debriefing or alternative forms of support;
n the conditions for public awareness development and the training
of interested professionals.
2.4 How does the Psychology of Emergency work?
At present we have 19 psychologists trained in Psychology of
Emergency. They are available on a daily basis from 8 a.m. to
9 p.m.
The request for intervention is made by the rescue teams on site
by calling the emergency number 118. The psychologists on-call
are contacted via the pager or by telephone.
Normally there are two psychologists on-call per day. Once they
have been alerted they check the information against the list
of indications and decide the steps to undertake.
Normally an intervention requires the presence of two psychologists;
sometimes, however, only one is available.
Whenever possible, the Psychologists of Emergency try to make
contact with the volunteers of the Spiritual Assistance in Emergency
to carry out the intervention together.
2.5 Let us have a look at the list of indications for interventions:
Ø SID (spontaneous, immediate death of children)
Ø Mortal accidents involving several people: always when
children and youths are affected
Ø Suicide
Ø Identification of the deceased and death notification
to the family in particularly distressing situations
Ø Disasters, catastrophes
Ø Violent crimes
Ø ...
2.6 Who cooperates?
As has already been mentioned, we have 19 psychologists trained
in Psychology of Emergency. They attended 180 hours of training,
including both theory and practice, in two years.
The training was given by Dr. Gisela Perren-Klingler of the Institute
of Psychotrauma, Switzerland.
The contents included psychotraumatology, neurophysiology, salutogenesis,
communication and linguistics, stress management, defusing and
debriefing as well as strategies to elicit resources and promote
resilience – both on an individual and on a group basis.
The training was entirely financed by the local administration.
On their part the participants committed themselves to cooperating
with the service for at least 3 years following the training.
Those psychologists who don’t work for a public institution
receive a fee for each intervention.
2.7 How is the service of the Psychologist of Emergency structured?
The group of psychologists has a very simple structure, with
a leader and a substitute.
The group meets four times a year for supervision and training
as well as to discuss organisational aspects and other relevant
issues.
2.8 In emergency coordination is all
From the very beginning the coordination of the two services
has been an issue: the Spiritual Assistance in Emergency offered
by qualified laypeople and peers on the one hand and the Psychology
of Emergency on the other.
As the volunteers and the psychologists got to know each other
better and experienced the need and advantages of cooperating,
the interest in more and better coordination at the level of the
implementation of the services increased.
In particular the psychologists have contributed to promoting
the process of institutionalisation, as I am going to explain
later on.
2.9 What are the characteristics of the Psychology of Emergency?
The interventions of the Psychology of Emergency are preventive
and based on salutogenesis.
The psychologists work together with qualified lay people and
peers.
The service promotes the coordination between the different psycho-social
services and institutions of the Province. Hence it acknowledges
and activates the social and local resources, referring those
in need to mental health professionals or other suitable institutions,
if necessary.
The Psychology of Emergency contributes to promoting the psycho-social
awareness and competence of the general public and more social
solidarity also at the administrative level.
Interventions are una tantum.
Wherever the volunteers of the Spiritual Assistance in Emergency
are not available, the psychologists take on the interventions
during their day shifts.
2.10 Positive experiences and by-products
n Concrete experiences in the intervention practice are required
and indeed fundamental for psychologists to experience their own
attitudes, needs and skills and to protect themselves and others.
Not every good psychologist is also a good psychologist of emergency.
n The opportunity to meet and to cooperate with the members of
the emergency department (number 118), the volunteers of the Spiritual
Assistance, the peers of the rescue teams and the authorities
has been and continues to be fundamental in order to understand
failures, cooperate better and, in case, improve timeliness.
n The prejudice against the “others” has gradually
given way to the appreciation of each others’ contributions
thanks to personal contact and the experiences made during the
interventions.
n The possibility to refer people to other colleagues and mental
health professionals or the psychosocial institutions gives a
sense of relief when we are on site; in fact if the persons involved
or the members of the rescue team need defusing or debriefing,
we know that we can rely on qualified colleagues.
n When difficult interventions on site are required, knowing
that reliable colleagues can perform organisational work i.e.
find telephone numbers and personal data, inform the authorities,
etc. and, in case, plan alternative forms of crisis intervention
is fundamental and indeed reassuring.
n In time the demand for debriefing or support for involved family
members or friends is increasing and also kindergartens, schools
and other institutions require our interventions. We should know
that we can’t do everything ourselves as we are a small
group, and that we need to rely on qualified colleagues well-trained
in traumatherapy.
2.11 Difficulties and open issues
n Getting the necessary information during the first phase of
an intervention is difficult and operators have to deal with this
insecurity.
n A frequent problem is that the list of indications is not always
complied with by the members of the emergency service 118 for
various reasons. Therefore a battle of power to establish who
is in charge or competent is often engaged in. Sometimes interventions
are also required by hospitals, but these cases are outside our
area of competence.
n Our colleagues have often to drive for one or two hours before
they reach the site of the intervention. In fact, sometimes no
other colleagues living or working nearby are available. Hence
we need more psychologists specialised in Psychology of Emergency.
n A problem we are confronted with time and again is communication.
How do we communicate with each other to get and to provide clear
information, so that teamwork can function properly and the feedback
is appropriate?
n Another question arising is: what do we do differently by comparison
to volunteers? In time the conviction has developed that psychologists
cannot and should not do more than volunteers on site do. Psychologists
are often overqualified and tend to stick to their usual settings.
Nonetheless we have decided to continue our work as Psychologists
of Emergency on site because it is a significant experience from
a practical perspective. At a later stage we would be prepared
to step back, if there is an adequate number of qualified volunteers
of the Spiritual Assistance.
2.12 Let us have a look at the statistical data of last year,
the first year of operation of the service
Last year there were 86 interventions and 19 debriefings with
rescue teams, families, kindergartens, schools and tourist groups.
Over 2/3 of the interventions were carried out together with the
volunteers of the Spiritual Assistance in Emergency.
2.13 What are the prospects for the future?
The present group of Psychologists of Emergency should be reinforced
by a second group whose training is starting in 2007 once more
under the direction of Dr. Gisela Perren-Klingler and her team.
In this way the service could be extended to 24 hours a day and
be reachable throughout the Province. Through the process of institutionalisation
both services – the Spiritual Assistance in Emergency and
the Psychology of Emergency – should be implemented better
and teamwork improve.
Furthermore, contacts with other similar groups inside and outside
the Province should be promoted, in order to improve the efficiency
of interregional interventions.
Meetings for common training could be organised together with
the Spiritual Assistance in order to reflect on experiences and
better qualify each service.
In the future we need more specific meetings, both for supervision
purposes and the evaluation of the service we provide.
Furthermore increased attention should be devoted to the area
of public relations.
3. The process of institutionalisation of both services
3.1 Why do we need the institutionalisation of both services?
The institutionalisation of both services has been the subject
of discussion for some years now. Meanwhile it has reached a good
level, but more is needed to achieve our objectives.
The institutionalisation process involves several aspects:
1. In institutional terms the service of the Spiritual Assistance
in Emergency is integrated in the rescue organisation White Cross.
It is not supported by the local administration either juridically
or financially.
2. Both services, the Spiritual Assistance in Emergency and the
Psychology of Emergency should be connected to the network of
the rescue organisations, the department of the emergency number
118, the authorities and other relevant organisations and institutions
such as the Catholic Church or other religious communities, which
are typical of this region, to ensure cost-effective and efficient
coordination.
3. For both services a central office with one full-time operator
should be established for coordination and organisational purposes.
3.2 How to develop a project for the process of institutionalization?
The teamwork performed by the operators of the Spiritual Assistance
in Emergency, the Psychology of Emergency and the department of
the emergency number 118 has enabled us to elaborate the project
known as “First aid for the soul“. The proposal was
made to gather all the rescue organisations and the local and
religious institutions in a new association bearing this name.
The coordination staff should be in charge of the coordination,
cooperation, management and organisation of both services and
the development of future initiatives.
3.3 Where are we?
In May 2006 the idea of a new association to coordinate both
services was accepted by the local administration. The coordination
unit – so the idea - could be situated and integrated into
the structure of the White Cross in order to benefit from the
existing administrative and organisational resources.
At the moment the administration of the Province is not prepared
to make any further investments, yet they cannot deny their financial
support without jeopardising the credibility and structure of
both services in the long run.
3.4 The coordination unit
The coordination unit will be based at the headquarters of the
White Cross in Bolzano.
A qualified member of the White Cross has already been chosen
as a coordinator. He has experience in the management sector and
in organisational development. He is a voluntary member of a rescue
team and a member of the staff of the Spiritual Assistance in
Emergency.
In June 2006 the staff for the coordination of both services
were recruited and next autumn the association responsible for
providing “first aid for the soul” will start operating
under the name of: “Arbeitsgemeinschaft für Notfallpsychologie
und Notfallseelsorge”.
First we intend to invite all the relevant organisations, inform
them and ask them to join the association. In this way all rescue
organisations, the administration of the Province and the local
Church would be connected to form a network. At a later stage
we will try to network also with other national and international
organisations.
Both services remain independent but they are oriented to each
other for the benefit of the victims and their relatives as well
as the members of the rescue teams.
The decision was made to set up a coordination team that meets
on a monthly basis to assess intervention operations under way
and to discuss difficulties and experiences. Regular supervision
enables detecting problems with reference to the criteria and
indications for intervention. Immediate feedback is essential
to evaluate interventions and verify the measures adopted.
Conclusion:
§ Both services started at peers’ level and developed
to form a larger network.
§ Through their cooperation they have determined a substantial
qualitative improvement in the work of the rescue organisations.
§ The presence and cooperation of qualified peers is fundamental
and contacts with specialized mental health professionals enable
to offer a wide range of assistance services on site and afterwards.
Both services are equally important.
§ The setting up of a central unit for coordination enhances
the role played by both services also at the administrative level.
It promotes a better coordination and cooperation during interventions
for the people concerned and the members of the rescue teams.
Consequently the roles of both services become clearer and more
transparent.
§ An example of good cooperation was the assistance to Tsunami
victims and parents and friends of Tsunami casualties, which the
two services provided together during the first four months of
2005.
§ Of course, much remains to be done in the future. But
some crucial steps have already been undertaken adapting the concepts
of Crisis Intervention and Spiritual Assistance in Emergency to
our local situation. Reportedly we are the first institution of
this kind in Italy, though the demand for similar services exists
in other Italian regions too.
§ Significantly, through the Spiritual Assistance in Emergency
and the Psychology of Emergency the psycho-social awareness and
competence of the general public has improved as has social solidarity
on the part of the administration.
§ The Spiritual Assistance in Emergency and the Psychology
of Emergency perform a fundamental human and social function:
being close to those in distress, supporting them in their suffering.
We do as much not primarily as professionals or an authority in
the field but in a spirit of solidarity, from human being to human
being, enabling people in distress to elaborate what has happened
and hope in life and the future.