Standard Operating Procedure (SOP) for Psychosocial Care and Support
Earthquake in Nepal – 25th April 2015:
Introduction
Disasters significantly impact the psychosocial wellbeing and development of the
affected population. Exposure to disaster, loss of or separation from family members
and friends, deterioration in living conditions, inability to provide for one’s self and
family and a lack of access to services can all have immediate and long-term
consequences for children, families and communities that impair their ability to
function.
This document use the term psychosocial support to describe any type of local or
external support that aims to promote psychosocial well-being and/or prevent or treat
mild to severe psychosocial problems and mental illness.
This document reflects the guidance set out in the "IASC (Inter Agency Standing
Committee) Guidelines on Mental Health and Psychosocial support in Emergency
settings". The work of the Psychosocial Support working group (under the protection
cluster)1 focuses on the bottom 4 layers of the intervention pyramid for mental health
and psychosocial support, which are as follows: 1) basic services and security 2)
community and family supports and 3) mainstreaming psychosocial support and 4)
focused non-specialized supports. (This guideline is contextualized in the local setting) The
top layer of the pyramid, focused on specialized care services, is the focus of the mental
health sub cluster (under the health cluster). However making referrals for specialized
care and provision of psychosocial support falls under the parameters of this SOP.
Provision of Psychosocial Support (PSS)
Different organizations have been providing crucial psychosocial care and support
including Psychological First-Aid for children and others who are vulnerable (children
and their parents, women and with disabilities including other vulnerable groups etc).
In addition, capacity enhancement initiatives are being implemented for Community
Psychosocial Workers (CPSWs), Teachers, female community health workers (FCHVs)
health professionals, key protection actors and other concerned stakeholders to support
the affected community to help them overcome difficult experiences caused by disasters
including the recent earthquake. These standards are designed as a guide for members
of the psychosocial work group (under the protection cluster). This is only the working
documents for disaster response but so this documents is made to have a common
It is agreed among the ministry of health and population and department of women and children along
with UNICEF, WHO and other NGOs working in mental health and psychosocial support that 'community
based psychosocial care and support is led by the protection cluster and mental health is led by the health
cluster. There is an assigned focal person to manage the data and coordination so WHO's focal person is
Dr. Rishav Koirala for Mental health & UNICEF resource person is Prakash Acharya for Psychosocial
support.
1
understanding among the psychosocial members. This document can be revised by core
technical groups.
Activities related to psychosocial support
1. Provision of psychosocial activities for children and other vulnerable
individuals, groups or families. This includes providing culturally and age
appropriate, safe and stimulating non-formal activities such as sports and
activities, play and games, art and drama and other recreational activities that
enhance life skills and coping mechanisms. The wellbeing of all people should be
protected by establishing or reestablishing security, adequate governance and
services that address basic physical needs including food, shelter, water, basic
health care and control of communicable diseases. These services should be
provided in ways which protect people’s dignity, strengthen local supports and
mobilize community networks. This also includes support for a small number of
people who are able to maintain their mental health and psychosocial wellbeing
if they receive help in accessing community and family supports. These types of
services might include family tracing and reunification, assisted mourning and
communal healing ceremonies, mass communication on constructive coping
methods, support parenting programs, formal and non-formal educational
activities, livelihood activities and activating social network such as women’s
groups and youth clubs.
2. Basic psychosocial care and support. Psychosocial support and emotional
support provided by community psychosocial workers (who are trained minimum
of 5 days) at the individual level, in a group or family setting. This will include
providing Psychological First Aid. Training can be provided to enable those who
are not trained on first-aid and basic psychosocial care are provided training in
the immediate aftermath of disasters and a move to community based
psychosocial support activities for the medium term”.
3. Provision of training. Capacity building for psychosocial care and support to
teachers, key protection actors, health professionals and other relevant
stakeholders such as CCCM (Camp coordination and camp management) actors
around delivering psychosocial support and offering care for care givers.
4. Provision
of focused psychosocial support/intervention:
affected
communities are provided different psychosocial intervention including
techniques and therapies by trained psychosocial counsellors and psychologist
and clinical practitioners in individual, group and family level.
5. Ensuring children, families and other vulnerable with more severe
psychological or psychosocial problems have access to professional help.
Some children families and other vulnerable groups experience emotional and
mental health difficulties that cannot be managed by their existing social support
network. These cases are referred to organizations that specialize in these issues.
Minimum standards for the provision of Psychosocial Duration of the program:

Minimum of 3 from started date months.

Training and qualifications: Minimum of 6 months psychosocial training on
community based psychosocial care or BA in psychology or Post Graduate
diploma in psychological counselling.

Supervision: Psychosocial workers are provided supervision from a psychosocial
counsellor. Psychosocial counsellors are supervised by clinical supervisors to
ensure the quality of services.
Coordination: All partners must coordinate with the District Women and
Children’s Offices related to psychosocial support interventions. Other concerned
government agencies, such as the District Public Health Office or the District
Education Office, must also be notified if capacity building and/or other services
are being offered/provided to health or education professionals.
Referral procedure: If the psychosocial counselors identify an individual in need
of specialized mental health support, refer to the referral procedure developed by
the mental health working group uploaded in humanitarianresponse.info
Monitoring & reporting: All partners to report through 5WS including number
of beneficiaries reached and at what level, on a weekly basis using 5Ws reporting
mechanism.
Ensuring quality: It is the responsibility of the clinical supervisors to ensure the
quality of the services clinical supervisors being the focal point for ensuring
quality the scope of psychosocial counselling and other psychosocial services.
Mobilizing existing mechanisms: Community psychosocial workers and
psychosocial counselors are encouraged to provide community based care and
support in coordination mobilizing and coordinating with
the existing
mechanisms
Appendix: Please refer to the appendix for list of partner organizations currently
providing PSS.
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Categorization of
Psychosocial care and
response
Psychological First Aid
Major Activities or Skills
-
Basic psychosocial
support
Observation, listening
and referral skills
Communication and
coordination skills
Self-care techniques
and tools
Human Resources with
required skills
Community leaders
(teachers, community
health workers, youth
leaders, political leaders,
religious leaders, students
and other service
providers, women
cooperatives, GBV watch
groups, youth clubs &
child clubs etc.) with at
least 1 day orientation on
PFA
Psychosocial support
through community
mobilization
-
-
Psychosocial Counseling
Support To reconsider the
decision to separate them
out from specialized
professionals.
-
Community based
psychosocial support
Psycho-education
Home based
care/follow-up
Basic listening and
communication skills
Peer support for
survivors
Do's and dont's in PSS
work
Identification of PS
problems in survivors
and referral
PS support to children
and high risk groupsbasic principles, simple
techniques of listening
to children
Focused and
structured (i.e.
protocolized)
psychosocial
intervention with
required skills in case
management
This is the basic level of
support that can be
executed by
nonprofessionals just after
post disaster situation
Community based
psychosocial workers who
received at least 5-10 days
of training on the content
described under activities
line
At least intermediate or +2
degree with training
psychosocial counselling
with sufficient clinical
practices
Psychosocial Counselors
(Intermediate passed) who
received at least 650-800
hours input through
training,
Likewise, training certified
by different organizations
such as TPO, CVICT, CMC
and others, training inbuilt both theory and
supervised practicum with
total hours ranged from
650-800 hours. After six
months of theoretical input
and backstopping support
and distance coaching,
they are trained as a
Psychosocial Counsellor.
-Those who have
completed academic
course in counselling
(graduate, PGD and
masters degree) are also
eligible for psychosocial
counselling.
-Graduate in psychology
with training in
psychosocial counselling
(at least one month) and
supervised practicum.
Specialized Care
-
Mental health
treatment including
intensive psychosocial
care and support
including specific
psychological
intervention according
to the nature of
psychosocial / mental
health problems of the
client
Psychiatrist/Clinical
Psychologist
Psychologist/Psychiatric
Social Workers/Clinical
Social Workers/
counselling psychology
(master and), psychiatric
nurse with supervised
practice in psychosocial
intervention
Medical Doctors or
Community health workers
who received relevant
training course and
undergone in practice and
regularly supervised by
national and international
psychiatrist / psychologist
Classification of Human Resources and their standard remuneration:j
Category
Minimum period of
training/supervision
Proposed
Remuneration
Remarks
Community
based
Psychosocial
Worker (CPSW)
Standard training (5-10
days) has to be completed
by all CPSWs for
providing community
based psychosocial care
6000-10000
The developed
standard outline
of training
course certified
by mental health
and psychosocial
as a minimum standard.
Based on the experiences
and performance within
the given time frame of 36 months, the salary
range can be varied.
Psychosocial
Counselor/social
workers (with
health and
mental health
specialization or
experience)
Person having at
20,000-30,000
least an intermediate
pass and having training
course of 650-800 hrs
(includes at least 350-370
hrs supervised practice
with client). At least
should be evidence of
provided counselling to
35 with 2 to 8 session (4
as an average, 15
individual counselling
and 20
group)counselling).clients,
with documentation
-Those who have
completed academic
course in counselling
(graduate, PGD and
master degree) are also
eligible for psychosocial
counselling. At least
should be evidence of
provided counselling to
30 clients, with detail of
documentation
-Graduate in psychology
with training in
psychosocial counselling
25,000-35,000
organization like
TPO, CVICT,
CMC and others,
can be used for
the training of
CPSW. For this
short-term
training of
CPSW, the
organizations
working in
mental health
and psychosocial
approach, can
jointly work for
standardization
and take
approval from
NHTC of MoHP.
Training outline
of six month
training course
has been
approved by
CTEVT but skill
test part is yet to
be developed.
Six month
training course is
certified by
different
organization like
TPO, CVICT,
CMC and others,
training in-built
both theory and
supervised
practicum with
total hours
ranged from 650800 hours.
(at least one month) and
supervised practicum
with 15 clients seen
under supervision
Psychosocial or
Clinical
Supervisor/
Clinical Social
Workers/ Social
Workers
Person having at least six
month training course
with supervised
practicum or having
above mentioned
educational qualification
with least 3-5 years of
extensively working
experience in
psychosocial approach
with directly working with
more than 70 clients
Clinical supervisor should
have professional degree
of Masters in clinical,
counselling psychology or
bachelor degree with
psychosocial counsellor
training with at least
three years’ work
experience as
psychosocial counsellor
with supervised practice
(at least 500 hours during
three years period)
OR
Experience of
psychosocial counsellor
with counselling practice
(providing service to
client) at least 300- 500
hrs plus practice
supervision of
practitioner counsellor.
Counselling practice
hours and supervision
hours can be certified by
psychosocial service
providing institute,
professional association.
35,000-40,000
+40,000
Note: The modular training content has to be adopted in order to develop community
based psychosocial counselors. Further, the new generation of BSW, BA can be
mobilized as counselors with assurance of minimum days/hours of training completed
on a modular basis.
Framework for Psychosocial Support
- Psychosocial
counselling
- Basic mental health
care by PHC doctors
- Support provided
by CPSW
- Supportive childfriendly spaces
Level 5: Specialized
support
Mental health care by
mental health specialists
(psychiatric nurse,
psychologist, psychiatrist,
psychiatric social worker
Level 4: Non specialized
community based support
Level 3: Reinforcing community
and family support
Level 2: Mainstreaming
Psychosocial support in different
services
-
Advocacy for basic
services that are
safe, socially
appropriate and
protect dignity.
Level 1: Providing basic service and
security
-Activating
social networks
- traditional supports
- Support provided by
different stakeholders ie
teachers, HPs, PFA
volunteers, healers.
Description of IASC Pyramid Level adapted for training, supervision, and
implementation practices in Nepal
IASC
Pyramid
Levels
Description
Services are
delivered by:
Service
providers are
trained by
Supervision
System*
Level 5:
Specialized
MHPSS
support
Clinical
mental health
care delivered
according to
disciplinespecific
professional
standards.
Accredited
multi-year
clinical
training
programs
Ongoing
professional
accreditation
requirements
Level 4:
Focused
MHPSS
support
Recognition
and
management
of basic
MHPSS
problems with
referral to
specialized
accredited
professionals
for
collaborative
care and
management.
Use of
evidencesupported
techniques,
and intensive
a. Mental health
care by
psychiatrists
(MD-Psych),
b. Clinical
psychological
(MPhil, PhDClinical
Psychology)
c. Psychologist
(M.A. , with
extensive
training in
psychotherapy from
certified
psychologist/
psychotherapi
st both
national and
international
a. Psychosocial
counselors (6month
training with
clinical and
didactic
training,
ongoing
supervision);
b. MBBS and
HAs with
clinical
training and
supervision
(e.g., 9-day
mhGAP or 6day mhGAPHIG with
regular
supervision
and monthly
refreshers)
a. Master's
Degree in
Psychology,
psychosocia
l counseling
with 5+
years of
ongoing
experience
and
supplement
al training
in specific
techniques
and
supervision;
a. Psychosoci
al
counselors
engage in
regular
peer
supervision
and period
supervision
of clinical
psychologis
ts
b. MBBS and
HAs receive
ongoing
supervision
from
psychiatrist
s certified
as mhGAP
supervisors
ongoing
supervision.
Level 3:
Strengthenin
g,
reinforcing,
and
supplementi
ng
community
and family
supports
Structured
support
through novel
cadres of
workers or
structured
environments,
e.g., CPSWs
and ChildFriendly
Spaces. This
level goes
beyond
sensitization
and
orientation
because
providers are
trained in
recognition of
problems,
basic
techniques,
and then
serve an
identified
MHPSS role.
Moreover,
cadres
delivering
services at
this level
receive
ongoing
supervision to
assure
minimal
quality
standards.
Community
Psychosocial
Workers
(CPSW+plus
model, minimum
of 5 to 28 days
straining with
ongoing
supervision; or
base CSPW
model (e.g., 1
week training)
with ongoing
supervision
Psychosocial
counselling
training
received from
recognized
organization,
academic
institutions
with at least 3
years’
experience in
providing
psychosocial
counselling
service to the
client (service
providing
experience at
community
level is
preferred) with
regular
supervision
from high level
recognized
psychosocial
professionals.
supervision;
Ongoing
supervision
from
psychosocial
counselors
Level 2:
Sensitization
and
orientation to
MHPSS
needs in
services
Mainstreamin
g of
psychosocial
support in
existing social
support
processed:
Activating
social
networks,
enhancing
communicatio
n skills, and
normalization
of
psychological
responses
through
enhanced
support
provide by
stakeholders
including
teachers,
women’s
groups, etc.
Minimal
quality
standards are
not required
for
verification of
services.
Non-specialists
(e.g., students,
FCHVs, women’s
groups, teachers,
etc.) who have
received 1-3 day
orientation
programs
Trainers may
range from
mental health
specialists to
CPSW+plus
model who are
receiving
ongoing
supervision
Supervision
may or may
not occur at
Level 2
Level 1:
Basic
services and
security
Advocacy for
good
humanitarian
practice:
basic services
that are safe,
socially
appropriate,
and that
protect
dignity
n/a
n/a
n/a
*Note: A basic requirement for Level 3 and above is ongoing supervision by a service
provider with extended MHPSS training (e.g., psychiatrist, clinical psychologist,
Psychosocial Counselor or psychiatric social worker)